ORIGINAL

ARTICLES

Nursing Faculty Practice: An Organizational Perspective SARAE. BARGER, DPA, RN, FAAN,*

KATHERINEE. NUGENT, PHD, RN,TAND

WILLIAM C. BRIDGES,JR, PHD$

After reviewing the faculty practice literature of the 1960s and finding philosophical support for practice but also growing concerns about faculty role overload, the authors report a study to identify organizational factors that influence the role expectations of faculty members about practice. A survey was sent to the deans or directors of all National League for Nursing-accredited baccalaureate nursing programs (n = 462). Of the 356 respondents (76 per cent), 224 (63.3 per cent) reported that their school had practicing faculty, but only 20 schools (6.6 per cent) required practice. W&ten faculty practice plans were reported by 23 schools (10.2 per cent), and nursing centers by 41 schools. Thirty-six respondents (16 per cent) repotted that practicing faculty generated revenue for the school. Practice was required for promotion in 15.6 per cent and for tenure in 15.3 per cent of all schools surveyed. The study showed significant direct relationships between master’s and doctoral programs and practicing faculty, but there was an inverse relationship between the presence of a health science center and schools with practicing faculty. Organizational factors relating to both the number and per cent of faculty who practiced included requiring practice, having a practice plan, and having practice as a criterion for promotion and for tenure. Revenue generation and presence of formalized practice arrangements were related to the number of faculty who practlced but not the per cent of the total faculty who *Professor and Chair, School of Nursing, Northern Illinois University, DeKalb, IL. TAssistant Head, Department of Nursing Science, College of Nursing, Clemson University, Clemson, SC. *Associate Professor, Experimental Statistics, College of Agricultural Sciences, Clemson University, Clemson, SC. Address correspondence and reprint requests to Dr Barger: Department of Professional Services, School of Nursing, Northern Illinois University, 1240 Normal Rd, DeKalb, IL 60115. Copyright 0 1992 by W.B. Saunders Company 8755-7223/92/0805-0005$03.00/O

practiced. The study’s findings have Implications for nursing education in designing organizational structures and rewards that support faculty practice. (Index words: Faculty issues, practice; Nurslng faculty practice) J Prof Nurs 8:263-270, 7992. Copyr/gM 0 1992 by W.8. Saunders Company

F

ACULTY PRACTICE,an important 198Os, continues to capture the

issueinthe

attention nurse educators in the 1990s as efforts continue unify the profession. This interest is evidenced by inclusion for the first time of faculty practice items

of to the in

the fall 1990 survey of the American Association of Colleges of Nursing sent to all academic institutions offering a baccalaureate Although philosophical the subject nizational Therefore,

abounds,

or higher degree in nursing. and theoretical literature on there is little

research on orga-

factors that influence faculty practice. the purpose of this study was to identify

organizational factors in schools of nursing that affect faculty members’ practice. This article summarizes the current literature on faculty practice, with particular emphasis on faculty practice research. Then the subject is examined within the conceptual framework of role theory, focusing on the influence of the organization. Next, a study of organizational factors affecting faculty practice is described, and findings are presented.

Finally,

these results

are examined

in the

context of the impact of nursing educational organizations in shaping the roles of nurse educators. Review of the Literature Faculty practice emerged as one of the major philosophical issues of the 1980s. Although models to

Journal of Professsionul Nursing, Vol 8, No 5 (September-October),

1992: pp 263-270

263

264

BARGER. NUGENT, AND BRIDGES, JR

unify nursing Smith’s (1964)

education and practice efforts at the University

the 1950s and were continued 1985) at Case Western

began with of Florida in

by Schlotfeldt

(Fagin,

Christman

(1979) at

Reserve,

Rush, and Ford (Ford & Kitzman,

1983) at the Uni-

versity of Rochester

in the 197Os, it was not until

1980s that everyone

began talking

tice. Perhaps Academy

it was the resolution

of Nursing

1979, stating

(1979

to

that “the American

the

about faculty pracof the American 1980),

released

Academy

ing endorses the idea of cementing

ment of the discipline. for meeting

this criterion:

practice”

(p. 4) that launched

Following

the relationship

Programs

meeting,

which

and Higher

practice roles in nursing education. Concentration on the issue of faculty made

possible

Johnson

by a grant

Foundation

from

De-

on faculty practice

the Robert

to the American

was

Wood

and com-

must

include

the realities

of everyday

patient

care; (3) the

must move the faculty

member

tion and maintenance

of clinical

Malasanos, 1986). Cosponsored with the American Academy of Nursing, these symposia were held in 1983, 1985, 1986, and 1987. Through these conferences and the resulting publication of their papers, the philosophical, theoretical, and practical issues of practice

lyzed.

Noticeably

practice. Similarly,

were described,

the

1980s was largely

absent faculty

were practice

philosophical

beyond

mere acquisi-

skills;

practice ought to be funded differently

practice

and (4) the

than teaching.

.

.

for

activities

to

be

faculty practice: “they must be scholarly in orientation with associated scholarship outcomes and they must have the care of patients or clients as their central focus”. . . considered

Nurses Founda-

tion, which funded four symposia on faculty practice (Barnard, 1983; Barnard & Smith, 1985; Feetham &

faculty

be

(2) the practice plexities

of

League for Nursfocused

must

or limits;

in

the issue for the 1980s.

of Baccalaureate

(1) the practice

of Nurs-

such devices as faculty

closely was the National

ing’s (1980) Council gree

through

four conditions

focused in some way, with clear boundaries

m

service and education

She described

explored, research

and anaon faculty

literature

of the

and descriptive

in

nature. Beginning with Mauksch’s (1980) seminal article, “Faculty Practice: A Professional Imperative,”

As the decade of the 1980s progressed, the literature shifted from theoretical and philosophical support for faculty practice to more emphasis on the identification of the practical issues of that practice. Millonig (1986), while identifying the benefits of faculty practice, also identified the following barriers: ( 1) the time needed for practice conflicts with time needed for teaching and scholarly pursuits, taining appropriate and acceptable barriers

to reimbursement

(2) difficulties obpractice sites, (3)

of faculty

for practice,

(4)

conflicts of commitment to both the educational and practice setting, and (5) limited recognition for fac-

faculty practice was exhorted as a vital role component for nursing educators. Reasons cited in the literature in support of faculty practice included enhancement of the quality of teaching, increased credibility in the classroom, identification of research opportunities,

ulty practice in the promotion and tenure area. Furthermore, she identifies a barrier that is “in some way related to all of the other barriers” (p. 170), the barrier of role strain. In fact, a number of articles on faculty practice focus on role issues. Wakefield-Fisher (1983) identi-

improved clinically

fies potential sources of role strain when the expectation of practice is added to the current role obligations

patient care (Millonig, 1986), insurance of competent faculty, improvement of rela-

tionships with nursing service, revenue for the college of nursing, and increased control over the practice environment for the faculty and the college (McCloskey & Kerfoot, 1984). Ford and Kitzman (1983) identified two criteria for activities to be considered faculty practice: “they must be scholarly in orientation with associated scholarship outcomes and they must have the care of patients or clients as their central focus” (p. 13-14). This definition was expanded by Algase (1986), who contended that faculty practice must also contribute to advance-

of nurse educators

and questions

if faculty

practice

is

a realistic expectation for faculty. Rodgers C1986) supports this point of view because the majority of faculty members hold master’s degrees as their highest earned credential. She states that if faculty members add both practice and doctoral study to the standard faculty role requirements of teaching, research and service, chronic overload will result. Neely et al. (1986) clearly disagree, contending that practice is a piece of the development of the nursing faculty role that occurs through the synthesis of theory, education, re-

NURSING FACULTY PRACTICE

search, and practice.

Although

that more research component

265

is needed

of faculty

these authors conclude on faculty

search is extremely

limited.

research,

as it is, addresses

tional

limited

and personal

as a component A study

practice

Nevertheless,

factors related

of faculty

by Anderson

both

organiza-

to faculty

(1983) explored

of faculty

practice

inhibiting

factors that faculty

National members practicing

programs

(N

=

who were engaged faculty

to determine

their clinical

League for Nursing

calaureate

members

skills. Deans of

(NLN)-accredited 306)

faciliperceive

identified

in practice.

bacfaculty

Of the 972

who were sent question-

naires, 573 (59 per cent) responded. The majority of participants were 40 years old or under (57 per cent), married (54 per cent), without dependants (57 per cent), and had been teaching 5 years or less. The majority were not engaged in research or scholarly writing. They practiced mainly for personal reasons, specifically, enriching their teaching, maintaining clinical skills, and personal satisfaction. Concerning institutional supports, only 37 per cent reported that their school’s written philosophy included faculty practice. lotted stated

The majority

reported

that their school al-

no time for faculty practice. Only 10 per cent that their school had a reimbursement policy.

Practice was a component a teaching

position

these were the only studies

ined organizational

of the evaluation

and individual

of faculty practice,

tigating

the effects of faculty practice

veloped

clinical

Polifroni,

and Organek

of beliefs, fessional

sites

were (1986)

believed that students reacted positively to their practice, but only half felt that faculty viewed it positively. In a more recent study (Barger & Bridges, 1987), the relationships of both personal and organizational

from one school of nursing.

studied

the relation-

and student

acquisition

associated

with pro-

students Results

and

of 137

14 faculty

indicated

that

students taught by practicing faculty scored higher on three of the seven professional characteristics variables-integration of theory into practice, realistic perception of the work environment, and use of nursing research. They reported more internal source of control, a higher degree of autonomy, higher selfconcept and self-esteem, and more professional and bicultural role behavior than did their classmates who were taught by faculty not in practice (p. 297).

Boettcher (1989) examined the effect of academic nursing practice centers on faculty job satisfaction. Thirty-two centers in 25 states and 124 faculty members participated in the study. Findings indicated a high level of job satisfaction among faculty, the majority of whom were untenured

in these centers.

administrative policies do not affect the extent of faculty practice, but personal factors such as age, marital status, and education (doctoral degree) do. . . .

factors to the extent of faculty practice were explored. In the first phase of the study, deans or directors of

Maurin (1986a, 1986b) vices provided by schools

NLN-accredited baccalaureate programs provided demographic data on their schools and administrative

schools surveyed,

policies. A sample of 41 schools was selected for the second phase. In a survey of 1,507 faculty members of these schools, 1,036 (68.7 per cent) participated by providing demographic data on themselves and information about the extent to which they practiced. Results indicated that administrative policies do not affect the extent of faculty practice, but personal factors such as age, marital status, and education (doctoral degree) do. Of particular concern to the authors was the inverse relationship between an earned doctorate of practice.

Kramer,

The sample consisted

nursing

inves-

and faculty de-

criteria for

in the schools of only 26 per cent

of the respondents. Respondents identified administrators as the greatest facilitators and work load as the primary inhibitor of faculty practice. Most (95 per cent)

and the extent

and in-

identified.

and attributes

craftsmanship.

senior baccalaureate

exam-

three other studies

faculty practice

values,

that

facilitators

hibitors

ship between

and Pierson

to maintain

practice

role.

tating

when trying

re-

the existing

the problems and/or

as a

role, in fact faculty practice

Although

also studied of nursing.

nursing Of the

58.5 per cent responded,

ser400

but only

23 per cent (n = 55) indicated that their school sponsored a clinical project. Effects of the clinical project on the school’s degree program in rank order were (1) better clinical learning experiences for students, (2) clinical research initiated, (3) higher faculty satisfaction, and (4) solved a clinical learning site shortage problem. Moreover, statistically significant differences were found between schools that sponsored clinical projects and those that did not. Schools with clinical projects were more likely to have the status of a school or college, be in a health sciences center, and offer a master’s degree program. These schools also

266

BARGER, NUGENT. AND BRIDGES, JR

had more

intramurally

and extramurally

funded

re-

2. What

ganizational

search projects. Although

the studies of Kramer,

ganek (1986), 1986b)

Boettcher

examined

faculty-developed Anderson

(1989),

Polifroni,

clinical

and Pierson

faculty

will

sites,

believed

that

factors

(1986a,

practice

practice.

only the studies

Because

affecting

and

practice

and

was indi-

cated. taking Kahn

model

of organizational (1978)

the study.

provides

of factors

involved

roles developed the conceptual

in the

between

specific or-

and the percent

equivalent

of the

(FTE) faculty

who

for

survey was conducted

The following

operational

Faculty practice has the following

these

definitions

were

1. Provision

central

attributes:

of service or care to clients

IS the

focus.

2. Practice occurs at times other than when the faculty member is engaged teaching of nursing students.

degree the content of a given office. What the occupant of that office is supposed to do, with and for whom, is given by these and other properties of the

to examine

used in this study.

by Katz and framework

the role expectations held by members of a role-setthe prescriptions and proscriptions associated with a particular office-are determined by the broader organizational context. The technology of the organization, the structure of its subsystems, its formal policies, and its rewards and penalties dictate in large

Thus,

An exploratory questions.

In this model,

organization

factors

total full-time practice!

of fac-

the likelihood the Barger

of organizational

faculty

specific or-

who practice?

is the relationship

ganizational

by

5 years ago, the authors

a reexamination

The theoretical

3. What

and

between

factors and the number

ulty members

(1983) and Barger and Bridges

Bridges study was completed personal

and Or-

and Maurin

the effects of faculty

(1987) focused on factors that influence that

is the relationship

j

Practice

has as its goal

in the clinical

the continued

dd-

vancement of nursing care of patients/clients, a goal congruent with the advancement ot nursing knowledge. 4. The practice leads to individual growth and consists of more than maintenance of clinical skills,

itself (p. 196).

if we are to understand

the role expectations

and the role sent by the role senders, and the role received and the role behavior of the office of faculty member, we must first understand the organization.

Because Katz and Kahn (1978) between

variables and the role expectations

assert that there is

certain

organizational

held about and sent

to a particular position (p. 196), the purpose of this study was to identify organizational factors that influence the role expectations of faculty members about practice. The investigators questioned if schools where faculty members practice differ from schools where no faculty members practice. Also of interest was the identification of organizational factors that facilitate or inhibit faculty practice as a follow-up study to the earlier work by Barger and Bridges (1987). Specific research questions examined included: 1. Are the demographics ulty members practice where they do not?

of schools where facdifferent from schools

of It

should be noted that the authors specifically excluded moonlighting with this closing statement, even though statements I through 4 excluded it by virtue of the specific criteria. This definition of faculty practice refined the operational

Purpose

“a causal relationship

Al~rtlnll$ting is not included in the definition faculty practice for the purposes of this study.

definition

used in the ear-

lier work by Barger and Bridges ( 1987), which inactivities in the clinical environment for the

cluded

purpose

of supplementing

sonal need to practice believed that a higher given the since the Nursing that is an

income

or fulfilling

(moonlighting). level definition

a per-

The authors was in order,

advancement of the area of faculty practice previous survey. center was defined as a nursing practice site integral component of the nursing academic

unit. This was the same definition used in the earlier work by Barger and Bridges (1987).

Methodology A survey instrument for deans and directors of schools of nursing was developed after extensive review of the literature and the content of the four Academy Faculty Practice Symposia (Barnard, t983; Barnard&Smith, 1985; Feetham & Malasanos, 1986)

NURSING FACULTY PRACTICE

and the meeting Higher

Degree

roles (NLN, structure

of the Council Programs

1980).

were collected

in less than

whether

sciences master’s,

the theoretical it had faculty

practicing

faculty

collected

regarding

ticed,

10 minutes.

istence

of a practice formalized

plan, practice

doctoral),

the number and

If there were

of faculty

Thirty-six practicing with cent),

revenue,

and criteria for promotion and tenure. In January 1990, questionnaires were sent to all NLN-accredited baccalaureate nursing programs (n = 462). Three hundred sixty-two schools responded,

screening

faculty

no practicing

faculty.

The relationship

between the two groups and nominal data was tested using chi square (Question 1). For schools with practicing faculty, the number of practicing faculty was coded, and the percent of faculty who practice of the total FTE faculty was calculated. A linear model was defined that related number of practicing faculty to all the factors of interest (both quantitative and qualitative). Analysis of variance was used to test significance of factors in the model. Similarly, a second linear

private that

for the school, from

$300

to per

was kept by the schools.

to the faculty

In 12

went to the faculty, ranging

from

11 per

cent to 100 per cent. In the areas of promotion and tenure, 35 schools (15.8 per cent) required practice for promotion, and 34 (15.3 per cent) required it for tenure. The number of faculty practicing in schools ranged from 1 to 140, with a median of 4, a mean of 8, and a standard cent of faculty

schools with

model,

of these schools (53.8

with percentages

deviation

faculty

clinics and health

revenue ranging

of the revenues

and

practicing

generated

amounts

all the income

into

with

those

(16 per cent) reported

schools, a percent

two

schools

programs,

In the majority

for a response rate of 78 per cent. For purposes of analysis, schools were divided groups:

other

including

a unification

respondents

revenue

who prac-

of a nursing

arrangements,

contracts,

1986). Nev-

per cent) identified

case loads, and joint appointments.

$600,000.

the ex-

practice

departments,

data were

for practice,

down by 10 from the 51 schools re-

58 schools (25.9

with hospitals,

it

its academic

arrangements,

ertheless,

Specific data whether

the existence

center,

these centers 5 years ago (Barger,

formalized

basis of its curriculum,

the number

nursing porting

allowed it to

in the school, additional

center,

the

center,

who practiced.

the school’s requirements

and

practice

participation,

on the school’s affiliation,

(bachelor’s,

of faculty,

faculty

of the questionnaire

was a part of a health programs

of Baccalaureate

addressing

To maximize

and length

be completed

267

of 12.03 practicing who practice

faculty/school. in each school

The perranged

from less than 1 per cent to 94 per cent; the median was 30 per cent, the mean was 36 per cent, and the standard

deviation

was 0.27.

having a master’s program greatly increased the likelihood of the school having practicing faculty. . . .

model was defined for the relationship of the percent of practicing faculty to all the same factors, and results of the two models were compared.

The statistical

analysis system computer software package (SAS, Cary, NC) was used to perform the calculations.

Findings Of the 354 respondents, 224 (63.3 per cent) reported that their school did have practicing faculty, and 130 (36.7 per cent) reported no practicing fac-

Schools with practicing faculty differed from schools without practicing faculty in several key areas. There was a significant inverse relationship between the presence of a health science center and schools with practicing faculty. In contrast, having a master’s program greatly increased the likelihood of the school having practicing faculty. The relationship between the presence of a doctoral ulty was also significant,

program and practicing facalthough not at the same

ulty. Only 20 schools (8.8 per cent) required practice. The remaining demographics are reported for schools

level (Table 1). Larger schools also were more likely to have practicing faculty (Table 2).

with practicing faculty. Twenty-three schools (10.2 per cent) reported a written faculty practice plan; 53 (23.6 per cent) reported an informal practice plan; and 149 (66.2 per cent) reported no plan. Of those schools with either formal or informal plans, 23.3 per cent had existed for less than a year, and 46.7 per cent had existed for 1 to 5 years. Only 41 schools operated a

Specific organizational factors were found to be related to the number of faculty members who practice. As seems obvious, requiring practice related strongly to the number of faculty who practiced. Moreover, having practice as a criterion for promotion and tenure also related strongly to the number of faculty who practice. Other organizational factors related to the

BARGER, NUGENT, AND BRIDGES, JR

TABLE

1.

Differences in Demographics Between Schools With and Without Practicing Faculty

TABLE

3.

Factors Relating to the Number of Faculty in a School Who Practice

Schools With Practicing Faculty

Schools With No Practicing Faculty

Ownership Public Private

129 99

64 68

2202

138

Presence of health science center Center present No center

51 177

16 115

5652

017

lf = ,001. tP = .Ol. $P = .05.

003

an organization’s

Variable

Master’s degree program Has master’s program No program

P

X2

School requires practtce School has practice plan School has nursing center Other formalized practtce arrangements Criterion for promotion Criterion for tenure Revenue generated

the taking 54 78

130 98

8681

of orgaruzational

9 123

33 195

I ’

roles. They contend rewards,

ties dictate in large degree the content practice 4 754

029

is required

center was not related to the number of faculty who practice, but having other formalized practice arrangements was related at the .OOl level (Table 3).

or rewarded

supports,

such

72’ 62t 37 30” 75’ 87~ 60$

that

and penal-

of a given role,

of this study.

When

through

the criteria for promotion and tenure, ber and per cent of practicing faculty organizational

of faculty who practiced were having a practice plan and generating revenue. Having a nursing number

35 4 2 23 17 9 4

2

formal policies,

and that is the finding

Doctoral program Has doctoral program No program

F

df

Factor

faculty

inclusion

in

both the numincrease. Other

as having

a practice

plan, generating revenue, and developmg formalized practice arrangements. may also help, but rhe relationships were not as strong. Although the study showed that formahzed prac-

Finally, the relationship between specific organizational factors and the percent of a school’s total FTE

tice arrangements and revenue generation were related to the number of faculty who practiced, they were not related to the per cent of faculty in a school that

faculty who practice

practice.

was investigated.

Again,

ing practice had the expected impact of faculty who practiced. Including criteria

for both promotion

requir-

on the per cent practice in the

and tenure

also continued

for the number

to exhibit strong relationships to the per cent of practicing faculty. However, generating revenue and having formalized practice arrangements, as well as havin this ing a nursing center, fell out of significance model (Table 4).

of this study lend support

Kahn’s (1978) theoretical TABLE

2.

Mean no. of faculty Standard deviation

to be due to the

of practicing

faculty was much greater

than is possible within a standard deviation for percentages. This greater spread that was possible in the raw number of faculty who practiced probably accounted for these factors being significant in the model relating the number of practicing faculty to

to Katz and

model of factors involved

in

Schools With No Practicing Faculty (N = 130)

28

19

31.6

164

TABLE

4.

Factors Relating to the Per Cent of Faculty in a School Who Practice Factor

Differences in Number of Faculty Between Schools With and Without Practicing Faculty Schools With Practicing Faculty (N = 224)

appear

these factors, but not in the model relating the per cent of practicing faculty to these same factors. The

Discussion The findings

These differences

difference in the standard deviations for the two measures of faculty participation. The standard deviation

P

0004

School requires practice School has practice plan School has nursing center Other formalized practice arrangements Criterion for promotion Criterion for tenure Revenue generated *P = .OOl. fP = .Ol. *P = .05.

df

F

1

1837’ 8 09” 0 47 0 71 13 99* 14 40‘ 1 69

2

1 I 1

269

NURSINGFACULTYPRACTICE

lack of a relationship

between

and either the number supports

the findings

criterion

for promotion

possibly synergistic bination

and

by the

4. What

and analyses

effects of practice

as a

tenure.

and

The

joint

effects of these two factors in comit would

5. How do peers react to faculty Although

the findings

self-evident

to be important

(Anderson

Bridges,

1987), the likelihood

and percent of faculty

question.

The school’s location was not conducive

of the organization in whether

within

faculty

a health

to practice,

also were practiced.

science

center

in spite of presumed

excellence and complexity in facilities. The size of the faculty was also important, with larger schools being

& Pierson,

Institutional

arrangements, one fourth

study appear

the findings 1983;

supports

practice, practice

were in evidence of the schools

in only approximately

in this study.

faculty in the current study have no practice criteria for promotion and tenure, it is unlikely that the number of practicing faculty will increase. In fact, Katz It seems then that leaders in nursing decide

marily quantitative and presented tive on faculty practice, additional

educator. study were pri-

the deans’ perspecresearch is needed

to focus on the more qualitative aspects of faculty practice. Therefore, the authors are in the process of conducting a delphi survey of practicing faculty that will address from the point of view of faculty members the following 1. What

factors facilitate

is the desired

education

role of the

nurse

We spent the decade of the 1980s in philo-

sophical support of the inclusion of faculty practice in that role. The decade of the 1990s will require practical support through organizational structures and rewards that send a clear message: Nursing is a practice profession, and our educators are practitioners par excellence.

The authors gratefully acknowledge the assistance and support of deans and directors who not only completed the organizational survey, but who also assisted in the identification of practicing faculty for the next qualitative study.

faculty prac-

tice? 2. What personal factors inhibit

what

that they will de-

Acknowledgment

questions: personal

Moreover,

when over 80 per cent of the schools with practicing

must

hood of practicing faculty. Because findings from the present

& in

for faculty

cline.

the likeli-

Barger

plans and formalized

master’s

increased

of earlier

of their use remains

and Kahn’s (1978) model suggests

programs

faculty

who practice?

significantly more likely to have practicing faculty than smaller schools. In addition, the existence of and doctoral

faculty

inhibit

of the present

and in fact support

such as faculty practice

The size and structure

factors

studies

who practice. found

organizational

effects of these

to assess the combined

and other factors on the number

factors facilitate

practice?

was not assessed. In future studies,

be important

3. What organizational practice?

center

study

1987). the models

the individual

faculty

a nursing

of the previous

authors (Barger & Bridges, It should be noted that used assessed

having

or per cent of practicing

faculty practice?

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and

Christman, L. (1979). On the scene: Uniting service and education at Rush-Presbyterian-St. Luke’s Medical Center. Nurse Administration Quarterly, 3, 7-40.

Fagin, C. (1985). Institutionalizing practice: Historical and future perspectives. In K. E. Bernard & G. R. Smith (Eds.), Faculty Practice in Action (pp. 1-17). Kansas City, MO: American Academy of Nursing.

facand

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