Introduction

Among the many wonderful things about being a nurse is the opportunity to make career changes within the profession. This home study course has been developed to assist nurses who are considering a career in nursing academics. The course provides background information about the growing need for nurse educators in the United States, describes how nursing and nursing education is changing, and helps learners develop a personal plan that can lead to an academic career.

Chapter 1 describes the impact of nursing faculty shortages, outlines changes affecting nursing practice and education, and reviews educational preparation and personal qualities needed for a successful academic career. Chapter 2 discusses reasons for nursing faculty shortages, identifies potential short- and long-term strategies to alleviate the faculty shortage, and describes the rewards of being a nurse educator. Chapter 3 focuses on significant changes in the role of professional nurses and how these changes affect nursing education. This chapter also discusses the characteristics of today’s nursing students and outlines developments in nursing curricula and instructional strategies. Chapter 4 discusses how to get started. A self-assessment helps learners evaluate their personal suitability for an academic career, and an action plan outlines steps to achieve success. This chapter also directs learners to sources of financial aid for graduate study. Throughout this course, learners will hear the voices of nursing faculty sharing their experiences and perspectives about this unique and vital area of nursing specialty practice.

Nurse educators will influence the future of the nursing profession in the United States. Students starting nursing programs today will need skills and knowledge beyond what is now known by the time they graduate. Changing nursing roles will demand continual innovations in curricula. Nursing faculty will need to be more flexible and creative than ever before. As the American Association of Colleges of Nursing states, “Never have the opportunities been greater; never have the challenges been more difficult; never have the outcomes been more significant.”¹

Chapter 1: Who Will Teach Nursing's Next Generation?

The purpose of this chapter is to encourage nurses to consider an academic nursing career and to inform them about the consequences of the nursing faculty shortage in the United States. After studying the information presented here, you will be able to —

• Describe the impact of nursing faculty shortages on America’s health and the nursing profession.
• Discuss changes affecting nursing practice and education.
• Describe the education and personal qualities needed for an academic career.

Nearly everyone is aware that we're in the midst of a significant nursing shortage. The good news is that applications to nursing programs, enrollment in programs, and numbers of graduates have increased over the last several years. The bad news is that despite five consecutive years of increased enrollment, over 32,000 qualified applicants were turned away from entry-level baccalaureate nursing programs in 2005 because there weren’t enough faculty to teach them.^1,2

The National League for Nursing (NLN) describes nurse educators as the vital link needed to prepare enough registered nurses to provide quality care for the American population.³ The Health Resources and Services Administration projects that more than 1 million more RNs will be needed by 2020.⁴ By 2030, the percentage of the U.S. population age 65 and older will increase to 20%, up from about 13% today.⁵ This translates to an additional 30 million older Americans seeking health care, requiring an estimated 3 million more nurses.⁶ A "perfect storm" of factors have combined to create the present faculty shortage.

Some experts believe that even if colleges and universities could produce enough nurse educators tomorrow to teach students on admission waiting lists, the problem still wouldn’t be solved.⁶ The prospect of not having enough nurses to meet the anticipated demand is now high on the radar screen for government and health organizations.

Nursing science endangered

Another crisis is on the horizon: the possibility that significant advances in nursing science will slow or even come to a halt.⁴ Nurses working today, particularly those educated in the mid-20th century, can recall a time when nursing was one of the few occupations available to young women. Student nurses staffed hospitals, and graduate nurses were subservient to physicians. As a profession, nursing is still young; it is in only the past several decades, due to the vision and efforts of nurse scholars and researchers, that nursing has developed a scientific body of knowledge that is disseminated to the nursing community at large.⁴ For nursing to fulfill its mission, these efforts must continue and expand. The nursing profession must have a sufficient number of educators to prepare the next generation of nurses and a sufficient number of researchers and scholars to continue to advance nursing science. Ironically, at the same time evidence-based practice findings are driving improved patient care outcomes, nursing still doesn’t have a comprehensive body of research that answers questions about the ways students learn and the most effective ways to teach them. This important need can be met only by recruiting more nurses into academic roles.^3,5

What it takes

Those who become nurse educators have several things in common: a passion for nursing, high standards of practice, a commitment to life-long learning, creativity, flexibility, excellent communication and critical thinking skills, and an interest in helping students grow and develop. If you have these qualities or are willing to develop them, consider acquiring the educational background that will prepare you as a nurse educator. The nurse practice act in each state determines the qualifications nurse educators need. Some nurse practice acts distinguish between the academic qualifications of instructors who conduct clinical teaching and those who provide both classroom and clinical instruction. Accrediting agencies, such as the NLN and the American Association of Colleges of Nursing (AACN) require full-time faculty to have doctoral degrees. Increasingly, doctoral preparation is encouraged.^3,5

Nurse educators with master’s degrees begin their teaching careers as junior faculty, instructors, or assistant professors. Many graduate students continue to work while they study part time, and most graduate programs accommodate the needs of practicing nurses. Students in master’s programs usually have baccalaureate degrees in nursing. An increasing number of graduate programs offer BSN-to-PhD programs. Others have a generic master’s programs for students who have a nonnursing baccalaureate degree. Students in these innovative programs move through graduate level work at an accelerated pace.⁷ Most graduate programs require applicants to have a 3.0 undergraduate grade point average and some require desirable scores on the Graduate Record Examination. Some schools require faculty to have doctoral preparation to be eligible for promotion to the higher academic ranks of associate professor or full professor.⁷ In addition to teaching students, faculty with doctorates are typically expected to demonstrate expertise in clinical practice, service, and creative activities, such as publishing, providing leadership in professional organizations, and conducting research. Nurse educators fill positions ranging from adjunct (part-time) clinical faculty to deans of colleges of nursing.⁷ Students come from a variety of backgrounds, ranging from recent high school graduates to practicing nurses studying for advanced degrees.

In most situations, nursing faculty teach courses that correspond with the focus of their graduate nursing education program.⁷ Colleges and universities generally hire educators to teach med/surg nursing, pediatric nursing, psychiatric nursing, obstetrics, and, in baccalaureate programs, community health nursing.⁷ Some faculty also teach in areas in which they have evolved as specialists through academic preparation or personal study or experience, such as nursing leadership or healthcare management. Whatever the clinical or professional specialty area, nurse educators are first and foremost teachers and must be skilled in teaching strategies, evaluation of learning outcomes, curriculum development, plus have the ability to guide learners to reach their full potential.

Some clinicians think that nurse educators work in an ivory tower, detached from nursing’s real world. Nothing could be farther from the truth. To be effective teachers, nurse educators devote time to keeping their knowledge base up-to-date and make sure they are aware of new developments in nursing practice and research so they can teach them to their students.^5,8

An academic career has many rewards. (See the sidebar.) And check out the NLN website to hear the voices of nurse educators around the county. A special feature, Great Moments in Teaching, features personal stories about the rewards of a teaching career.

Nursing faculty shape the knowledge and practice of new nurses on a grand scale. Many nurses remember the influence that nurse educators have had on the way they practice nursing every day. As a clinician, you are responsible for your own practice and have control over the care you provide to individual patients. But as a nurse educator you have the opportunity to directly influence ways in which a generation of nurses provide care.⁸

Nurse educators in academic settings may work on nine- or 12-month contracts. Faculty salaries vary depending on a person’s rank (e.g., assistant professor, associate professor); level of education; and the type of institution. Although the disparity between faculty salaries and those in clinical settings is cited as a barrier to entering academia, many nurse educators who work on nine-month contracts earn additional income by teaching during the summer or working on funded grant projects. Nurse educators also have predictable and flexible work that fits well with home and family responsibilities. In contrast to nurses in clinical settings, faculty aren’t called upon to work overtime and have regular time to learn, plan, and do research. The rewards of a nursing academic career are many, and the future is bright for nurses who choose teaching as a career.

Traditionally, nursing students were a homogenous group. Most were young women who entered nursing programs immediately after high school. In contrast, 21st century nursing students are an extremely diverse group. For one thing, they are older, often in their late 20s or 30s. They are also financially independent, bring work and life experiences to the academic setting, and strive to balance their studies with job and family responsibilities.⁵ Changes in student demographics and characteristics, along with their unique expectations for learning experiences, require that faculty develop innovative teaching strategies.

Today's educators know things have changed. "In my nursing preparation, I practiced basic skills in a laboratory 'bedroom' with five 'crank-style' hospital beds occupied by pieced-together manikins," says Kelli Brooks, RN, MSNEd, a nursing instructor at Cerritos College in Norwalk, Calif. "In today’s skills labs, students get to know their manikins by name, history, and diagnoses and follow them through an array of complications. These simulations allow students to recognize and respond to 'real-life' situations. Instructors can build into scenarios important bedside nursing care issues and introduce potential errors in care so that students can learn the results of their actions in a controlled environment rather than in the hospital."

What students want

Today's students expect coursework to be practical, relevant, and tailored to their needs. Often, classes are at satellite locations and scheduled one day a week or in the evening or on weekends to accommodate student work schedules. Nurse educators serve as architects, educational program designers, mentors, and competency evaluators.⁹ New learning technology is altering traditional classroom-based education, making it possible for learning opportunities to occur in various sites and for learners to be in direct communication with faculty and other students in many healthcare settings.¹⁰

"There’s a high interest in simulated clinical scenarios, Web-based information, chat rooms, interactive video conferencing and standardizing didactic information across multiple sites," says Judy Papenhausen, RN, PhD, director, School of Nursing, California State University, San Marcos. "New technologically based learning strategies allow educators to know students much better. No more sitting in the back row and not participating or not getting feedback."

One of the primary new roles for faculty is to help students select learning strategies based on personal needs, learning style, and experience. Faculty develop educational materials, help students choose learning materials, and verify that learning has occurred.¹⁰ The NLN emphasizes that significant changes in nursing education are on the horizon and that nurse educators should focus on creating environments that maximize student potential and advocate for resources to support their own educational and scholarly development.¹¹

"Today’s students are not the same nursing students of yesteryear," says Stephanie Vaughn, RN, PhD, CRRN, assistant professor, department of nursing, California State University, Fullerton. "They are technology savvy and have access to resources such as the library and their instructor 24/7. They may experience role overload juggling school, work, and family obligations." Vaughn says that nursing instructors need to listen to students' concerns, be as flexible as possible, and develop ways to empower students. "What we teach needs to make sense to students and to be applicable to their practice. I have found that by giving of myself, the rewards are many."

While 60% of nursing still occurs in hospitals, the profession is on the verge of a major transformation. Some experts forecast significant changes in nursing practice that will demand a new focus for nursing and nursing education. Twentieth century nursing focused on taking care of dependent ill people and providing increasingly intense health interventions in a highly technological environment.¹¹ In the near future, many illnesses now treated in intensive hospital settings will be prevented or detected in their early stages. As a result, nursing’s focus will increasingly be on counseling, teaching, and guiding people to achieve and maintain optimum health. At the same time that the “what” of nursing is changing, the "how" of nursing education is changing, as well. Nurse educators are being asked to develop courses on genetics, caring for the elderly and vulnerable, bioterrorism, health economics, health politics and policy, mass casualty response, palliative and end-of-life care, and patient care management. These and other topics will prepare 21st century graduates to practice in a dynamic and often unpredictable healthcare climate.¹⁰ Students in nursing programs today enter an increasingly fast-paced, competitive, and business-oriented environment. Students need to learn how to provide care in multiple settings with a diverse group of clients and to function in an environment in which not every patient need can be met. To fulfill their role as managers of care, student nurses will need to learn how to manage and supervise subordinate assistive staff.¹²

Sneak preview

If you’re up to the challenge of an academic nursing career, start by looking for ways to get a sense of what today’s nurse educators do. Seek out opportunities in your organization to precept or mentor new staff or nursing students and assess the rewards you gain. By volunteering to develop and teach inservice programs, you will begin to experience the exciting work of reviewing nursing literature, evaluating directions for evidence-based practice, and communicating new developments to your colleagues. Talk to nursing faculty who bring students to your agency — ask them about what they find most satisfying about their work. If you find that you like teaching, your next step is to locate a graduate program that meets your needs. Fortunately, finding information about nursing education careers and graduate programs is easier than ever thanks to several Web-based resources. (See "Educational and Financial Resources.") The AACN sponsors FacultyCareerLink an online resource that features a nurse educator career profile, a list of programs that prepare nursing faculty, financial aid information, and links to faculty development programs.⁵ Federal and private funding is often available to help students interested in enrolling in graduate nursing education.

Easing the loan load

The Nurse Reinvestment Act includes a student loan repayment program for nurses who agree to serve as faculty after graduation.⁷ In addition to developing an awareness of nurse educator careers and their rewards, the American Nurses Association and the AACN have been working for more federal support for the Faculty Loan Repayment Program. This program, sponsored by the Department of Health and Human Services, offers up to 85% of loan cancellation for nurses who serve as full-time faculty members.⁸

Nurses for a Healthier Tomorrow, a coalition of 43 nursing and healthcare organizations, is seeking ways to inspire a new generation of nurse educators.⁷ Its campaign features stories of nurse educators that highlight the rewards of teaching and a nurse educator career profile, accessible on the NHT website, www.nursesource.org. Without nursing faculty, there won’t be enough professional nurses to meet the country’s needs. Nursing needs to attract an increasing number of men and women who want to work with students as their primary "clients" and who want to pursue teaching as their primary role.¹³ Future nursing faculty, standing on the shoulders of past and present nurse educators, must be excited about designing effective curricula and presenting it to students and must be dedicated to developing evidence-based teaching strategies for nursing’s future generations.

Chapter 2: Don’t Miss Out On an Exciting Career

This purpose of this chapter is to describe the rewards of a nursing academic role, the personal challenges, and the challenges nursing as a whole faces in providing enough faculty members to teach future generations. After studying the information presented here, you will be able to —

• Discuss the rewards of being a nurse educator.
• Identify six factors contributing to nursing faculty shortages.
• State potential short- and long-term strategies to alleviate nursing faculty shortages.

It’s an inspiring experience to talk to nurse educators about their roles. They readily point to example after example of the professional and personal benefits of choosing a teaching career, and they’re equally candid about discussing some of the challenges they face. This chapter will focus on the many benefits of a nursing academic role, some of the challenges nurse educators face, and the overarching challenge the nursing profession must meet to produce enough faculty to teach future generations of nurses.

It’s personal

Nursing faculty serve in a variety of roles that range from adjunct (part-time) clinical faculty to deans of colleges of nursing. Faculty teach diverse groups, including recent high school graduates, students returning to school after years of work experience, and practicing nurses pursuing advanced degrees. Faculty typically describe interaction with students and watching their students gain skill and confidence as the most rewarding aspects of their role.¹ (See sidebar.)  Besides the personal rewards of working with students, nursing faculty have access to cutting-edge knowledge and research, work in an intellectually stimulating environment, often have flexible work schedules, and experience a high level of job security.¹

Besides having a direct impact on the future practice of their students, nurse academics can influence patient care across the country and even internationally. For example, Cynthia Jacelon, RN, PhD, CRRN, assistant professor, director of the Departmental Honors Program, School of Nursing, University of Massachusetts, Amherst, has significantly influenced the nursing care of older adults by obtaining research grants to support her study of the needs of the elderly across the healthcare continuum and publishing numerous articles on the subject.

An immediate threat

Despite the many rewards of teaching future nurses, the number of nurse educators has declined at the very time more Americans will need nursing care.

In 2005, the American Association of Colleges of Nursing (AACN) surveyed 395 schools, finding a mean of 2.9 vacant faculty positions per school and an 8.1% vacancy rate. Although this rate may not seem problematic, especially compared to nursing vacancies in some healthcare agencies, even one or two vacant positions has a significant impact on the teaching workload of other faculty.²

According to a survey done by the National League for Nursing (NLN) in 2006, about 1,390 budgeted, full-time faculty positions across the country were unfilled.³ The same survey reported a 7.9% vacancy rate for baccalaureate and higher degree programs, a 32% increase since 2002. Associate degree programs reported a 5.6% vacancy rate, an increase of 10% since 2002.³ Although more part-time faculty are being hired to alleviate the shortage of full-time faculty, they are not usually involved in designing, implementing, and evaluating the overall nursing curriculum and have other work commitments that may limit their availability to students.³ Although the NLN supports doctoral preparation for faculty , more than 56% of current full-time baccalaureate and higher degree faculty do not hold a doctoral degree.³

Why a shortage?

Like their clinical counterparts, nurse educators are getting older. The mean age of nurse academics with doctoral degrees has increased from 49.7 years in 1993 to 54.3 years in 2004. The mean age for faculty with master’s degrees has increased from 46 years to 49.2 years during the same period.² With many current faculty predicted to retire in the next decade, recruiting nurses into academic positions is critical.

However, a major barrier to drawing in more potential nurse educators is a continuing salary differential between nurses in academic positions and those with graduate degrees working in clinical settings. Regardless of academic field, most educators earn less than their counterparts in nonteaching settings. For example, a 2003 survey showed that a doctorally prepared associate professor of nursing earned an average of $74,556 in a calendar year compared with the $113,100 earned by a vice president for nursing. An assistant professor with a master’s degree earned $55,262 compared with a salary of $69,416 for a nurse manager.¹ Salaries for clinical positions have increased in relation to faculty positions because most colleges and universities are limited in their ability to raise faculty salaries.⁴ Inadequate compensation in academic institutions may also discourage master’s-prepared nurses from considering a doctoral degree and pursuing an academic career when they can earn higher salaries in clinical settings.²

Paying for tuition and repaying loans for graduate study are also significant disincentives for nurses considering academic careers. In addition, nurses who reduce their work hours while completing graduate work may lose a considerable amount of income. Fortunately, financial assistance and loan forgiveness are increasingly available for nurses who intend to pursue academic careers. How to seek financial assistance for graduate study will be discussed in Chapter 4 of this series. Ideally, nurses who earn doctoral degrees in their 30s will serve in academic positions for several decades. However, compared with those who earn doctoral degrees in other fields, nurses earn doctoral degrees at a later age.² As a result, the number of years they have to teach and conduct research is limited.

Retaining new nursing faculty members is an important aspect of ensuring an adequate supply of nurse educators. The nursing literature describes dissatisfaction with the workplace as a reason why younger faculty depart academic settings.⁴ Chapter 4 provides information about efforts that can help support new faculty to be successful and satisfied with their career choice. Changing role expectations for faculty are also cited as a source of job dissatisfaction. The way in which higher education is conducted is changing rapidly, often requiring an increased time commitment.² Most faculty members spend extended hours outside the classroom or clinical setting advising and mentoring students, updating courses, and reading to remain current with nursing practice. In a recent survey, a majority of respondents reported frustration with the lack of time needed to complete work.⁵

A whole new ballgame

Other factors affect the nursing faculty shortage, such as the characteristics and expectations of today’s students and major changes in the teaching curriculum and teaching methods. Faculty not only must adapt teaching methods to meet the learning needs of more nontraditional students, but must also address the wide range of student capabilities in the classroom, from very well-prepared students to those at risk for poor academic performance.² In contrast to the traditional lecture as a teaching method, faculty are developing more interactive teaching strategies such as case studies, problem-solving exercises, and research projects. Each of these creative approaches requires a considerable amount of time to develop and evaluate.²

Differences between generations in regard to work and study habits can produce stress for faculty. In addition to their primary teaching responsibilities, nursing faculty are also are expected to maintain clinical competence, to teach and supervise students in clinical settings, and to participate with other faculty in school events.² Nursing faculty who supervise students in hospitals are increasingly responsible for very sick patients. The dynamic healthcare environment also places new demands on nurse educators who must continuously develop curricula to prepare graduates to work in a rapidly changing environment. Chapter 3 discusses some of the changes in nursing and nursing education that affect the nurse educator role.

To have a fulfilling and successful academic career, nurse academics must have specific educational competencies. The NLN states that the ability to facilitate learning, design and implement appropriate learning experiences, promote the socialization and professional development of students, and evaluate learning outcomes are essential competencies for nursing faculty.⁶ However, over the past several decades, fewer nurses have opted to major in nursing education. In 1993, 9.5% of master’s degree graduates majored in nursing education. By 1999, this number had dropped to an alarming 2.5%.⁷

This significant drop in nursing education majors occurred in conjunction with increased interest in the nurse practitioner role. Since the mid-1990s, the majority of nurses enrolling and graduating from master’s programs are preparing for an NP or clinical nurse specialist role.² NP and CNS programs focus on preparing nurses for clinical practice rather than teaching. In the last decade, NPs have found an increasing number of well-compensated positions in both hospital and ambulatory clinical practice settings.

In addition to inadequate graduation from master’s and doctoral programs is a lack of interest in teaching as a career choice. At the same time that fewer master’s graduates have majored in nursing education, more doctoral graduates planned to be employed in nonacademic settings.² Many doctorally prepared graduates are primarily interested in research, and some institutions have reported that few of these graduates express an interest in teaching, and even fewer are interested in teaching undergraduate students.²

Strategies for change

The AACN and other organizations have proposed a number of short- and long-term strategies to increase and sustain appropriate numbers of nursing faculty:²

• Consolidate core curriculum requirements across nursing majors or clinical tracks
• Accept courses as appropriate from other disciplines to meet nursing program requirements
• Use non-nurse faculty to teach selected nursing courses
• Sponsor informational sessions to promote nursing academic careers among practicing nurses
• Reduce the perception that nurses must have years of clinical experience before pursuing graduate study
• Offer convenient class times and encourage institutions to provide flexible work schedules for nurses in graduate programs
• Recruit more second-degree students to the nursing profession and potential faculty roles
• Explore ways to have qualified retired faculty teach part time or advise or mentor students
• Increase partnerships between clinical facilities and schools of nursing
• Offer clinical faculty appointments to qualified clinical staff in exchange for supervising student clinical experiences
• Conduct research that helps legitimize teaching methods and strategies
• Re-examine faculty-student ratios to determine that they are appropriate in terms of patient safety and student
  learning
• Provide mentorship and coaching for new faculty to promote success in the role
  

The NLN maintains that nurses cannot learn to be teachers, advisers, curriculum developers, and academic leaders through on-the-job training; rather, adequate educational preparation is essential.⁶ The NLN recommends that some master’s programs develop or reinstate a curriculum track that prepares beginning nurse educators for full-time faculty roles in community colleges or for part-time or nontenured positions in universities to help individuals with advanced clinical skills make a successful transition to nursing education.⁶ It also proposes the creation of a doctoral program option that allows students to specialize in nursing education and conduct research about how best to teach the art and science of nursing.⁶

Long-term solutions to ensure a continuing supply of nursing faculty involve looking at recruitment, retention, and collaboration. One key long-term strategy is to deliver a positive message to secondary students about careers in nursing and nursing education.² Some believe that efforts to promote nursing as a career should be aimed at even younger age groups – elementary and middle school students – so that those interested can take the required mathematics and science courses in high school.² A career ladder that supports easier progression from basic nursing education to graduate education may also help draw more nurses into academics. Many in the profession believe that nurses must have several years of clinical experience before pursuing an advanced degree. The AACN suggests that moving qualified baccalaureate students directly into graduate programs will allow them to assume faculty roles earlier than the current norm.² By streamlining progression through graduate education, nursing may be able to attract younger students who can work part time and study full time.²

Another vital part of future recruitment is to help students pay the cost of graduate education, including providing financial aid that makes up for lost income while attending school. Chapter 4 discusses options for financial aid such as student loans that may be cancelled in exchange for a specific number of years of service as a nurse educator. Long-term efforts must also focus on retaining faculty. Increasing salaries and benefits and lowering faculty-student ratios will be key elements in attracting nurses to academic careers and retaining qualified faculty.² Finally, collaboration between nursing schools and legislators, members of other disciplines, and other professional nursing organizations is crucial to ensuring that schools are able to prepare enough nurses to meet the population’s healthcare needs.

Chapter 3: Nursing Education – Changing at Warp Speed

The goal of this chapter is to inform nurses about how to get started in an academic career. After studying the information presented here, you will be able to —

• Identify forces that are creating significant changes in nursing and nursing education.
• Describe characteristics of today’s students and how generational differences affect student expectations and performance.
• Discuss developments in nursing curricula and instructional strategies.

The primary purpose of nursing education is to prepare students to meet America’s healthcare needs. To accomplish this vital goal, nursing education must continuously adapt and evolve to prepare beginning practitioners for current and future nursing practice. Never in the history of health care has change occurred so quickly and so radically. Healthcare reform has produced significant changes in what care nurses provide and how they provide it. In the near future, scientific breakthroughs will change the focus of health care itself. Instead of allocating resources to treating disease after it occurs, the focus will shift to disease prevention and early intervention. These developments will have a major impact on what nurses will be doing and how they will be prepared to do it. At the same time, changing student characteristics and an explosion of education technology are challenging nurse educators to develop creative and innovative teaching strategies. The purpose of this chapter is to help those considering a nursing academic career to realize how these forces will affect nurse educators and nursing education.

The future is now

In response to escalating health costs in the latter part of the 20th century, the healthcare industry adopted managed care as America’s predominant healthcare delivery philosophy and delivery system. Essentially, managed care is a series of strategies designed primarily to control costs while preserving and improving quality of care.¹ The managed care system is more complex than previous delivery systems and demands advanced managerial skills, even from novice nurses. It is no longer enough for nurses to be expert in providing bedside care to patients: They must be able to direct and supervise others in delivering care that produces positive patient outcomes in a fiscally responsible way.

Managed care is driving changes not only in how health care is provided, but in where it is provided as well. Diagnostic and therapeutic technology is advancing at such a rate that in the next few years, much of what was done in hospitals will be done in physicians’ offices or clinics.² As a result, future nursing students will need to learn how to provide care to an increasingly diverse patient population outside traditional hospital settings.¹

Changes in what services nurses will provide to patients are also on the horizon. Comprehensive patient care is a care philosophy that has dominated nursing practice and education. Under this traditional model, nurses strive, often under incredibly arduous circumstances, to meet all the healthcare needs of each patient. In an era of limited resources, this model is unrealistic.¹ Instead, a care model that uses evidence-based practice interventions to produce realistic outcomes for patients will dominate nursing practice. Nurse educators will be challenged to introduce these new concepts into nursing programs as well as find ways to move nursing education from its traditional focus on acute care to a comprehensive community care model.

Fiscal pressures also affect colleges and universities. Nursing faculty are working at saving resources by increasing class size, increasing the number of students in clinical settings, and taking on heavier workloads.¹

Nurse futurist Tim Porter-O’Grady believes that the very foundations of health care  — and the nature of nursing itself — are changing. These changes will have a dramatic effect on what nursing students need to know, how they will learn, and the role of nursing faculty in preparing nursing’s future generations. "Nursing education is about to see the greatest challenge to both the form and process of preparing future nurses," Porter-O’Grady says.

In the 20th century, nurses spent the majority of their time providing direct patient care, administering medications and treatments, assisting ill patients with activities of daily living, and helping patients cope with actual and potential healthcare alterations. The educational focus for basic nursing practice was directed toward assessing variations from the norm, with the goal of helping patients regain their previous health status. Recent breakthroughs, such as human genome mapping, allow scientists to learn more about how the human body works, how disease processes develop, and how they can be prevented. RNA interference applications have the potential to alter disease development at very early stages. As a result, the purpose of health care will change, from an event-based illness model to a prevention and early intervention model.² Through gene mapping and other breakthroughs, healthcare professionals will be able to anticipate the potential for health alterations and intervene before the first symptoms of disease occur.²

In the next few years, healthcare interventions increasingly will be less invasive, shorter term, and delivered with a greater emphasis on life quality.² These trends mean that patients will no longer need the type of care nurses have been educated to provide in hospitals, and acute care hospitals will no longer be the focus of health care.² In the past 20 to 30 years, more than 70% of nurses worked in hospitals. Today, about 50% of nurses are hospital-based, and that percent will continue to fall as the healthcare system continues to change.² These developments have major implications for nursing and nursing education. Nurses will need to rapidly develop a new skill set focused on patient education and advocacy, and nurse educators will be on the cutting edge of preparing students to thrive in this new environment.

Generations and expectations

In addition to the dramatic changes in our healthcare delivery system, various factors have combined to produce the broadest range of age- and value-diverse employees in nursing academia and nursing service. In the past, the traditional nursing student was a 17- or 18-year-old high school graduate who went directly from high school into a nursing program, graduating in her or his early 20s. But from 1995 to recently, the average age of graduates from nursing programs has been about 30. However, the age of students is beginning to drop again, particularly at the university level.³ A majority of undergraduate nursing students, 73%, are classified as nontraditional, particularly in community college programs. Compared with their predecessors, today’s students are more financially independent and have competing job and family responsibilities.³ Understanding how generational differences affect everything from study habits to work attitudes can help future nurse educators adapt their teaching strategies to meet student learning needs.

Experts who study generational differences point out that our values are shaped during childhood by key events occurring in the larger society around us.⁴ Nursing faculty and nursing students come from one of four generations, and despite individual differences, members of the same generation tend to share values.

Veterans comprise two groups. The older group, known as the GIs (the term GI is an abbreviation for general issue, uniforms and equipment issued to military personnel), were followed by the "Silents", people raised during World War II and the Korean War. Although the younger members of the veteran generation are now retiring, they are still well-connected and influential.⁴ Key events that shaped the values of this generation include the Great Depression, the New Deal, World War II, the Korean War, and the golden age of radio and film. Veterans share several values: patriotism, dedication, sacrifice, hard work, conformity, law and order, patience, respect for authority, duty before pleasure, adherence to rules, and logical thinking.⁴ Boomers, the generation born right after World War II, now hold most of the important positions in health care. National prosperity, an emphasis on children, the rise of television, the growth of suburbia, political assassinations, the Vietnam War, the civil rights movement, the Cold War, women’s liberation, and the space race all occurred as boomers were growing up. Members of the boomer generation generally exhibit these values: a sense of optimism, a belief in change for the better, a preference for teamwork, and an interest in personal growth, health, and wellness.⁴

Generation X, those born between 1965 and 1980, are a dominant force in today’s workplace. Generation Xers were influenced by Three Mile Island, Watergate, a rising divorce rate, AIDS, MTV, computers, the Challenger disaster, an economic downturn, and the fall of the Berlin Wall. Core values held by Generation Xers include diversity, global thinking, technoliteracy, self-reliance, and pragmatism. Their "it’s only a job attitude" may put them at odds with the "thank God it’s Monday" boomers.⁴

The majority of today’s nursing students and future nurses belong to the Nexter, or Millennial, generation. Experts describe members of this generation as having been sheltered and raised like hothouse flowers. Threats such as school violence and the Oklahoma City bombing occurred during their childhood, with the evolution of the Internet, TV talk shows, and multiculturalism as other key influences.^4,5 Nexters tend to be achievement-oriented, optimistic, confident, and tenacious, and they live life at a fast pace.⁵ Balance in their lives is a fundamental value for Nexters.⁵ As children of workaholic boomers, they seek to balance personal time and career demands. They expect time off for family functions and don’t understand why job responsibilities should dominate their lives.^4,5 Experts observe that it’s not an aversion to working hard that drives their choices: It’s the expression of the value of family and friends, a commitment to having a full, balanced life in which work is only one segment.⁵ Loyalty also has new meaning among young people who saw their parents downsized, re-engineered, and laid off. As a result of these childhood experiences, young adults tend to look after their own interests first and show little loyalty to anyone other than family members and close friends.⁵

The book Geeks and Geezers, co-authored by management expert Warren Bennis, describes those who grew up between 1945 and 1954 as "geezers" and those who came of age between 1991 and 2000 as "geeks." Bennis further classifies geezers as people who were influenced by an era of limits and geeks as having grown up in an era of options. Geeks and geezers have three major differences:

• Geeks have bigger and more ambitious goals than geezers did at the same age.
• Geeks place more emphasis on achieving balance in their work, family, and personal lives than did geezers when they were younger.
• Geeks are far less likely than geezers to have had heroes or had their image of life success shaped by a hero.⁶

These significant generational differences can create discord between faculty from one generation and students from other generations. For example, faculty from the veteran or boomer generations have different views about work, authority, relationships, responsibility, and the nature of learning than today’s younger learners.⁴ Mature faculty, for instance, may expect students to have the self-directed study habits of previous generations. Most mature nurses followed study practices outlined in student handbooks, the traditional wisdom being that three hours of study outside of class was required for each credit hour. For a full-time student taking 15 credit hours, 45 additional hours of outside study was the norm. In contrast, a recent study described the study habits of freshmen at a four-year college. Sixty-three percent of full-time students reported studying 15 hours a week or less, and 19% spent only one to five hours per week in outside study.⁷

Although the Nexters describe themselves as confident and achievement-oriented, some organizational experts view this group as less independent than previous generations. As a result, Nexters may need more structure and supervision to reach their academic goals.⁴ As students with these characteristics enter nursing programs, faculty will need to provide detailed information about assignments, help students understand class preparation requirements, and identify the consequences of missing deadlines or being unprepared.³ A broad range of student capabilities, ranging from at-risk to exceptional, and more students for whom English is a second language, present unique challenges for nurse educators. Educational experts note that current undergraduates often lack basic skills needed for college-level work, with about one-third of high school students considered at risk for low academic achievement enrolling in four-year colleges within two years of high school graduation despite their at-risk status.³ Some of these students may wish to enroll in nursing programs. To reach their goals, students who lack prerequisite skills will need more attention and support from faculty.³

A dynamic field

To keep pace with today’s complex and unpredictable health care environment, nurse educators have made significant alterations during the past decade in how nursing education is provided, where it is provided, and how it is evaluated.⁸ A recent National League for Nursing (NLN) study examined changes in nursing education among 12 nursing programs in Connecticut. "The Changing Face of Nursing Education" table details some current and predicted changes in nursing education.

The results of this study showed that in just 10 years, from 1994 to 2004, some key aspects of nursing education have changed, and even more are predicted to change. Curriculum changes included an increasing focus on patient care outcomes and evidence-based nursing practice. The majority of the nursing programs involved in this study also reported a growing emphasis on emerging topics such as alternative therapies, holistic approaches to care, and forming collaborative partnerships with patients.⁸ Changes in teaching methods included greater use of problem-based learning, interdisciplinary learning, and educational technology.⁸ Data from this study clearly demonstrated that RN education is a dynamic and exciting field. However, the findings also suggested that while nursing programs continuously added content or learning experiences, content was rarely eliminated. Some experts believe that at the rate of knowledge acquisition in health care, it is unrealistic if not impossible to cover all desired content and that future nurse educators will need to have faith that students prepared with critical-thinking skills will be self-directed in their continuing education.¹ The NLN is encouraging faculty to reconsider the emphasis on subject matter and the traditional focus on complete content coverage.⁹ The NLN believes that nursing programs, both undergraduate and graduate, must challenge long-held traditions and develop curricula that are flexible and collaborative, are responsive to students’ needs, and integrate current technology.¹⁰

Critical thinking = critical skill

Nursing education is responding to a future that will require that nurses function as autonomous leaders, as expert in nursing economics and healthcare delivery systems as they are in the art and science of nursing. The role of nursing is changing so much and so fast that it’s difficult to have a clear picture of what nursing will be like in the future.¹¹ What is known is that 21st century nurses will need to be educated to be adaptable, flexible, and technically proficient. Most importantly, they will have to be critical thinkers. Examples of the course work that will receive future emphasis include:

• Critical thinking
• Leadership development
• Problem solving
• Research and evidence-based practice
• Clinical competency in a variety of settings
• Collaboration and communication
• Cultural competence

The strategies that are most likely to produce effective critical thinkers require that educators become learning facilitators. This role involves using instructional strategies such as discussion, asking provocative questions, and presenting clinical situations as the grounds for problem-based learning. Problem-based learning may be used as a teaching/learning strategy in a specific course or as the design for an entire curriculum. For example, instead of traditional anatomy and physiology or nursing care of older adults classes, student teams may work collaboratively to complete a series of problems that stimulate them to learn the concepts that faculty think are most vital.¹²

Nurse educators must also consider relinquishing some time-honored beliefs that may inhibit student critical thinking. Such beliefs include assumptions that the only way students can learn something is from instructors, that there is a single best way to think about and solve problems, and that faculty or preceptors should always take responsibility for making clinical assignments.¹² Because theory and practice converge in the clinical setting in a way that can’t be exactly replicated in a classroom, nurse educators must also determine the best ways to use clinical teaching experience.

Because finding student clinical placements can be difficult, instructors sometimes look to technology simulation to fill the gap.  But technology has its limits. "Simulation provides great opportunities for students to learn in a very safe environment; they can’t harm the manikin, but they can clearly evaluate their skill competencies and learn from mistakes," says Mary Beth Flynn Makic, RN, PhDc, CNS, CCNS, CCRN, senior instructor at the  University of Colorado Health Sciences Center School of Nursing in Denver. "However, I don’t believe simulation can adequately help learn the caring and communication skills needed to be a nurse: Students need access to patients."

Since the 1980s, many nursing programs have re-examined how their programs are designed, what they seek to accomplish, and how they support student learning. However, the NLN believes that what have been described as innovative practices have focused on adding or rearranging curricular content without making a significant paradigm shift.¹⁰ Also, many educators continue to teach as they were taught, thereby potentially preparing students to work in a healthcare system that is rapidly becoming obsolete.²

The NLN is also encouraging nursing faculty to more efficiently integrate technology into teaching through the use of distance learning and simulations, to provide students with clinical experiences in diverse settings, and to design learning experiences along the life continuum, from neonates to the elderly.⁸ Together with changes in curriculum, how students are taught has changed dramatically. Lectures in which learners play a passive role in the educational process have been replaced by exciting interactive teaching strategies. Today’s nursing students are more involved in activity-based learning activities such as simulations, games, case studies, Internet courses, and self-learning modules. Virtual clinical laboratories allow students to practice their assessment and diagnostic reasoning skills electronically. Rather than replacing one-to-one instruction, electronic media can augment the relationship between instructor and students.¹³ Where nursing education is provided is also changing. For example, distance learning, a method used to connect instructors with learners who are geographically separated, is becoming more common. Distance learning takes full advantage of modern satellite, Internet, and other communication technologies.¹²

Nursing education programs are becoming more research-based and are ideally taught by faculty who are well-prepared for their role and who demonstrate competence in the multiple components of that role. The NLN recommends that faculty identify themselves as advanced practice nurses who have the specialized knowledge and advanced education needed to teach future nurses. Nursing education programs today are designed to involve students as active participants in the educational process; be flexible to meet constantly changing demands and individual learning needs; be accessible and responsive to diverse student populations; and be accountable to the public.⁹

Health care reform and continued scientific progress is dramatically changing what health care will be like and how and where it will be delivered. The continuing knowledge explosion means that the nursing practice environment is becoming more complex. Future nurses will need new competencies that will be taught by the next generation of nurse educators. The NLN believes that nursing is on the verge of significant change in nursing education, and with major change comes opportunity. To take advantage of this opportunity and to position today’s students for tomorrow’s nursing roles, nurse educators must focus on student learning and creating environments that are characterized by collaboration, understanding, mutual trust, respect, equality, and acceptance of differences.⁸ It’s an exciting time to think about a career in nursing education, a place where nurse educators can shape the future of the profession.

Chapter 4: Getting Started on an Academic Pathway

The goal of this chapter is to provide nurses with resources to help them decide whether a career in nursing education is a good fit. After studying the information presented here, you will be able to —

• Assess your skill level and learning needs as a future nurse educator.
• Develop a plan to help you reach your academic goals.
• Identify the professional, personal, and financial resources you will need to accomplish your goals.

After reading the first three chapters of this course, we hope you are at the "considering stage." At this stage, you may have an interest in an academic career, but you’re not certain you have the skills needed, and you’d like to know how and where to get more information and what to do next. Answering those questions is a major focus of this chapter. Another goal is to provide you with the perspectives of nurse faculty. Their comments on how they made their personal journey to become nurse educators can help you chart your own career pathway.

Often, future nurse educators become interested in a teaching career because they find their unit-based teaching experiences rewarding. Serving as a preceptor for new graduates and volunteering to teach inservice courses are methods of determining whether teaching is for you. For example, Judy Papenhausen, RN, PhD, started her academic career as a staff nurse and learned that she loved to teach. "As an associate degree graduate, I started in my career in med/surg and critical care nursing," says Papenhausen, director of the School of Nursing at California State University, San Marcos. "I increasingly gained clinical experience and saw that others were interested in knowing what I had learned. So I started teaching classes and found I enjoyed having an audience to talk about areas of nursing that I loved."

Many nurses already have the qualities that will lead them to a successful academic career or can develop them through education and experience. Assessing your skills  requires honest introspection. First, assess yourself, and then ask others who know you well (family, friends, and colleagues) to give their assessments also. After completing this exercise, you will have a personal development plan to help lead you to an academic career.

First steps

The National League for Nursing (NLN) publishes two reference guides to help nurses find graduate programs and financial aid: the National League for Nursing Official Guide to Undergraduate and Graduate Nursing Programs and the National League for Nursing Official Guide to Graduate Nursing Programs. They list all U.S. nursing programs that complete an annual NLN survey and offer information on selecting a graduate program and obtaining scholarships and loans, including financial aid for minority students. Peterson’s Guide to Nursing Programs: Baccalaureate and Graduate Nursing Education in the United States and Canada, published with the American Association of Colleges of Nursing (AACN), profiles over 3,600 nursing programs offered by more than 700 colleges and universities.

In 2003, Congress allocated $20 million in funding under the Nurse Reinvestment Act.¹ This funding includes $3 million for a nursing faculty loan program that provides loan forgiveness for students in grad programs who agree to work as nurse faculty after graduating. Nursing schools will dispense this funding to students pursuing faculty careers. Many graduate programs also offer federally funded traineeships that pay tuition costs. And sometimes a nurse’s employer will help foot the bill. "Both my MSN and PhD were supported through tuition reimbursement programs from my employers," says Mary E. Mancini, RN, PhD, FAAN, associate dean for undergraduate nursing programs at the University of Texas at Arlington.

Take action

Start action on the professional and personal front to prepare yourself for an academic career.

Professional:

• Evaluate your education goals and determine what educational preparation you will need.
• Talk to nurse educators about the rewards and challenges of a nursing academic career.
• Inquire about the opportunity to "shadow" an instructor.
• Locate a graduate program that is congruent with your professional goals and that meets your needs.
• Talk with your employer about support while you are continuing your education, e.g., flexible scheduling.

Personal:

• Think about how your daily life will change while you are pursuing advanced education.
• Talk to your spouse, friends, family, and significant others about the personal support you will need while you are in graduate school.
• Decide what parts of your life can go “on hold” while you are completing a graduate degree.

Financial:

• Find out how much your graduate education will cost and what income you will need to forgo while in school.
• Investigate sources of financial assistance such as grants and loans.
• Talk to your employer about tuition reimbursement.

The rewards

Becoming a nurse educator brings great rewards: prestige, a flexible schedule, and an opportunity to make a mark on the direction of nursing.² However, becoming a faculty member also involves learning new skills, adjusting to an often unfamiliar clinical setting, becoming acquainted with the academic environment, and functioning as a liaison between the clinical and academic settings.² Fortunately, many resources are available to help new nurse educators transition to a complex role that involves teaching, scholarship, maintaining clinical competence, and continuing professional growth. The NLN cites research that shows that a mentoring relationship between a novice academic and an experienced faculty member can promote role transition.³ A mentor can answer questions, evaluate challenging situations, and provide direct assistance to a new faculty

In 2004 and 2005, the journal Nurse Educator published a series titled "Dear Florence." The goal of this series was to provide practical advice for new faculty members. For example, one column addressed the problem of a faculty member who was younger than many of her students. She was having trouble giving appropriate feedback to maintain high standards yet wanted to be perceived as a caring instructor. She said that one semester she’s known as "the Terminator" and the next as "the Pillsbury Doughboy." The two faculty authors of "Dear Florence" gave practical and relevant advice to help their colleague accomplish her goal of being a caring instructor who maintains high standards.⁵

Texts such as Clinical Instruction and Evaluation: A Teaching Resource provide invaluable information to a new nurse educator.² It has sections on how to communicate goals to students, motivate performance, provide positive and corrective feedback, prevent unsafe practice, discipline or fail a student, remove a student from the clinical area, and help students cope with stress. Other topics include how to help students cope with a patient’s physical disfigurement or death and how to respond to a patient’s racist or sexist remark or staff harassment. This text also provides new nurse educators with specific strategies for working with the reluctant learner; the monopolizer; the distracter; the student who lies or plagiarizes; the older student; the male student; the student who exhibits inappropriate behaviors; the student who is defiant; the poorly groomed student; the student who is a friend; the student who is repeating the course; the student who is licensed as an LPN or RN; and the student for whom English is a second language.² Examples of how to write clear and objective anecdotal notes about student clinical performance are also featured.

In 2004, the AACN launched an online resource called Faculty Career Link (www.aacn.nche.edu/CareerLink) to support nurses considering full- or part-time teaching careers. This information clearinghouse features a nurse educator career profile, academic programs that prepare faculty, financial aid opportunities, and links to faculty development programs.

To continue to thrive and even exist as a profession, nursing must identify and encourage those who have the talent and commitment to teach future generations of nurses. The nursing faculty shortage and its effect on the education and supply of the future nursing workforce have the full attention of the government and the healthcare industry. Significant efforts are being made to eliminate obstacles to an academic career and to find ways to support those who choose this fulfilling career path – a path that offers many rewards, both professional and personal.

"I not only received a formal education, but I learned additional life lessons in my graduate program," says Stephanie Vaughn, RN, PhD, CRRN, assistant professor in the department of nursing at California State University, Fullerton. "I met some wonderful colleagues and learned some interesting things about others and about myself. It truly broadened my horizons in many ways. I am thankful and appreciative of the experience and for the opportunity."