Research Briefs
Nursing Faculty Preparedness for Clinical Teaching Patricia Dunphy Suplee, PhD, RNC-OB; Marcia Gardner, PhD, RN, CPNP, CPN; and Bonnie Jerome-D’Emilia, PhD, MPH, RN
ABSTRACT Nursing faculty who teach in clinical settings face complex situations requiring evidence-based educational and evaluative strategies, yet many have had limited preparation for these tasks. A convenience sample of 74 nursing faculty participated in a survey about clinical teaching in prelicensure nursing programs. Most faculty developed teaching skills through conferences (57%), orientation at their educational institution (53%), or exposure in graduate school (38%). Thirty-one percent reported having no preparation for clinical teaching. Faculty felt least prepared to manage students with learning, physical, or emotional disabilities and incivility. Twenty-six percent had no preparation for evaluating students in the clinical setting, and only 17% had worked with a faculty mentor. Few evidencebased teaching strategies were used by the faculty. These findings indicate gaps exist in the preparation of clinical faculty. Graduate education, comprehensive orientation programs, and continuing professional development may help to ensure faculty are effective in managing and evaluating student learning. [J Nurs Educ. 2014;53(3, Suppl.):S38-S41.]
C
linical experiences in prelicensure nursing education allow students to develop problem-solving skills and clinical judgment, to learn to “think like a nurse” (Tanner, 2006), under the guidance of nurse faculty. The diversity of students entering nursing, an emphasis on interdisciplinary health care practices, increasing complexity of clinical environments, and incorporation of high-fidelity simulation are changing the context of clinical teaching at a time when evidence-based nursing education strategies to support students’ learning are increasingly emphasized. Clinical faculty can be expert clinicians but may be inadequately prepared to manage a variety of clinical teaching challenges demanding targeted educational and evaluative strategies (Cangelosi, Crocker, & Sorrell, 2009; Hewitt & Lewallen, 2010; West et al., 2009). To better understand the extent of this problem, the aims of this study were to describe preparation for clinical instruction and the clinical instruction experiences of faculty who teach prelicensure nursing students, identify the range of student challenges that clinical faculty encounter and their level of comfort in managing these challenges, and describe available mechanisms for mentoring and professional development of clinical faculty.
Background
Received: August 18, 2013 Accepted: November 11, 2013 Posted Online: February 17, 2014 Dr. Dunphy Suplee is Assistant Professor, and Dr. Jerome-D’Emilia is Assistant Professor, Rutgers University, Camden; and Dr. Gardner is Associate Professor, College of Nursing, Seton Hall University, South Orange, New Jersey. The authors have disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Patricia Dunphy Suplee, PhD, RNC-OB, Assistant Professor, Rutgers University, 311 North 5th Street, Camden, NJ 08102; e-mail: [email protected]. doi:10.3928/01484834-20140217-03
S38
Preparation for clinical teaching in nursing ranges from brief orientations provided by the university or college employer to continuing professional development to degree-granting programs. Clinical faculty report having unmet needs for information about academic and clinical policies and procedures, curriculum and course content, student evaluation, and simulation (Davidson & Rourke, 2012). Dahlke, Baumbusch, Affleck, and Kwon (2012) concluded that instructors often lack formal academic or continuing education preparation in clinical education, hold a diversity of views on the clinical teaching role, and tend to use their personal experiences as clinicians and students in constructing their roles. Grading and clinical evaluation are challenges for clinical faculty, who report difficulty determining clinical grades and assigning failing grades, and maintaining subjectivity in evaluation (Duke, 1996; Hall, 2013; Scanlan & Care, 2008). Although the numbers of nurse educator programs at the certificate, master’s, and doctoral level are growing, there is no national expectation that faculty, in general, and clinical faculty specifically, have formal preparation in educational methods. Typically, the requirement for clinical teaching in prelicensure programs is a master’s degree in a clinical specialty, subject to Copyright © SLACK Incorporated
RESEARCH BRIEFS
variation according to states’ nurse practice acts (American Association of Colleges of Nursing, 2008; Bartels, 2007; National League for Nursing, 2006; Ruland & Leuner, 2010). There is no consensus and little evidence to support any one form of educational preparation as best for the clinical faculty role (Davidson & Rourke, 2012).
Method Nursing faculty from the northeastern United States attending a faculty development conference were recruited to participate. Inclusion criteria were having a current role as a nursing faculty member and either supervising clinical instructors or engaging in clinical teaching. The study was approved by the university’s institutional review board. Of the 135 conference attendees, 74 completed the surveys. This descriptive study used a researcher-developed 14-item questionnaire based on current nursing literature. The survey included Likert-type and openended questions. Data analysis was conducted with STATA® software using descriptive statistics and bivariate analysis.
to make clinical assignments (47%). Topics that faculty reported learning about the least included: how to work with students with physical disabilities (12%), how to work with excellent students (19%), how to work with students who have learning disabilities (22%), how to work with students with emotional disabilities (26%), and how to manage legally mandated student learning accommodations (26%). When asked which clinical instruction challenges they were least prepared to handle, 42% reported working with students with learning disabilities, 39% reported working with students with physical disabilities, 39% reported managing students with emotional disturbances, and 36% reported managing student incivility (Table). Faculty from BS/BSN programs were significantly less prepared to handle students who had physical disabilities (p = 0.04) compared to those from AD and diploma programs. Faculty from all schools were least prepared to manage accommodations mandated by the school’s disability policy; this association was statistically significant (p = 0.03). Clinical Teaching Situations
Results In this sample of nursing faculty, 30% taught in diploma programs, 55% taught in associate degree (AD) programs, and 15% taught in baccalaureate (BS/BSN) programs. Eighty-two percent of the participants directly taught students in the clinical setting, and 39% supervised clinical instructors in a nursing course. The majority of the participants (60%) taught in nursing programs with fewer than 200 students. Educational Preparation and Development
Fifty-seven percent of faculty had attended conferences to prepare for clinical teaching, 53% had received orientation to clinical teaching at their educational institution, and 31% reported no preparation for clinical teaching. Thirty-eight percent had formal education about clinical teaching during graduate education, and 17% were assigned a faculty mentor when learning the role. When asked how they were taught to provide students with effective feedback, 58% stated they received instruction from the course director or coordinator; however, 26% reported receiving no training on providing effective student feedback. Regarding faculty development activities to support improvement in clinical instruction, 49% of participants reported receiving an evaluation of their skills by the course director or coordinator, 46% were offered an opportunity to attend workshops, 28% were provided with reading materials, 32% received a peer evaluation, and 16% reported that their academic institutions did not offer any faculty development. Faculty in diploma and AD programs were significantly more likely to receive continued development (p = 0.02) compared to faculty who taught in BS/BSN programs. Significantly more AD and BS/BSN programs provided faculty with reading materials and online resources compared to diploma programs (p = 0.02).
Participants were provided with 26 different clinical teaching encounters extracted from reports in the literature, and they were instructed to rate the frequency of their occurrence. Faculty reported often/always encountering and having to manage highly anxious students (57%), highly prepared students (54%), students who met clinical objectives easily (48%), and students with poor calculation skills (47%). The clinical teaching situations that participants reported they were least likely to encounter and needed to manage included conflicts with an attending provider (1%), student errors in care (nonmedication) (4%), students who refused to sign performance evaluations (4%), and students who communicated inappropriately with other health care staff (4%). When reported encounters and student issues were analyzed by program type, faculty from all programs reported never/occasionally having encountered incivility or rudeness (p < 0.01) or inappropriate communication with other health care staff (p = 0.04). Faculty from diploma and BSN programs were significantly more likely to report having to manage students with poor calculation skills compared to those from AD programs (p = 0.01). Clinical Assignments and Teaching Strategies
Eighty-one percent of faculty members used care plans as a clinical assignment. Group presentations (60%) and papers (58%) also were used frequently by faculty during clinical experiences. Teaching strategies that faculty used on a regular basis included postconferences (89%), chart reviews (80%), preconferences (77%), giving and receiving report (68%), and observational experiences (66%). Teaching strategies that were least likely to be used on a regular basis by clinical faculty included games (16%), reviewing research reports (18%), and interdisciplinary rounds (23%).
Educational Knowledge and Skills
The clinical teaching topics that faculty most frequently reported learning about from their institution or through their advanced education included: how to document student progress (61%), how to teach students to think critically (58%), and how Journal of Nursing Education • Vol. 53, No. 3, Suppl., 2014
Discussion Many clinical instructors do not receive adequate training for this role. In fact, 31% of participants in this study reported having had no training whatsoever, 38% had exposure to inS39
RESEARCH BRIEFS
approximately 11% of students in higher education have a disability (Snyder & Dillow, Clinical Challenges Participants (N = 74) Reported as Being Least Prepared to Handle 2012). Sowers and Smith Type n (%) (2004) reported 72% of their sample of nursing faculty had Working with students with learning disabilities 31 (41.89) taught students with disabiliWorking with students with physical disabilities 29 (39.19) ties; of these, 60% reported Managing students with emotional disturbances 29 (39.19) teaching students with learnManaging student incivility 27 (36.49) ing disabilities, 25% reported teaching students with physiWhat to do with students who seem to “know it all” 23 (31.08) cal disabilities, and 28% reEvaluating students who may be “just getting by” 22 (29.73) ported teaching students with Managing conflicts with clinical unit staff 21 (28.38) mental health disabilities. Considering the likelihood Managing accommodations mandated by the school’s disabilities office 13 (17.57) that nursing faculty will enDeveloping a remediation plan for students who need improvement 13 (17.57) counter students with various What to do with “star” students 13 (17.57) disabilities, both educator Grading care maps or care plans 11 (14.86) preparation and continuing education programs should Overseeing medication administration with multiple students 11 (14.86) integrate more information Working with nurse preceptors 10 (13.51) about best educational pracDetermining whether students are adequately prepared for clinical assignments 9 (12.16) tices for this diverse populaWhat to do with students who never seem to participate 8 (10.81) tion of students. Although faculty reported Working with students who have made errors 8 (10.81) rarely encountering incivilGiving constructive verbal feedback 5 (6.76) ity, 36% reported difficulty Running pre- or postconferences 4 (5.41) when confronted with incivility, suggesting the need Giving constructive written feedback 4 (5.41) for additional information Selecting clinical assignments 3 (4.11) and guidance. Most research Working with students from diverse backgrounds 2 (2.70) on incivility in nursing eduCompleting a clinical rotation evaluation of students 1 (1.35) cation has focused on faculty who teach in the classroom or in an online learning environment (Clark, Werth, & formation or experiences related to clinical teaching in their Ahten, 2012; Luparell, 2007). It is encouraging to note that graduate programs, and slightly more than half of the study parfew faculty in this sample encountered student incivility in the ticipants received an orientation to teaching students. Twentyclinical environment, given that incivility in higher education, six percent of the sample reported that they had received no including nursing education, has been reported to be a comtraining on providing student feedback. Appropriate feedback mon occurrence. is important in the learning process, and giving feedback is a Student issues that faculty reported more often encountercritical component of clinical teaching and evaluation (Gardner ing and needing to manage included dealing with those students & Suplee, 2010; Kelly, 2007). who are highly anxious, are highly prepared, and have poor calGiven the importance of clinical learning for development culation skills. Such issues may demand that faculty use speof clinical judgment, more attention to the preparation of efcialized teaching strategies to enhance learning. It is important fective clinical teachers is warranted. It would be beneficial for for clinical instructors to be aware of assessment strategies that academic institutions employing or preparing nursing faculty will allow them to identify and address students’ specific learnto offer programs addressing some of the faculty challenges reing challenges and strengths. ported in this study. Students who are extremely bright, have exceptional critical thinking skills, or go above and beyond the expectations set Educational Challenges for the course can present additional challenges to clinical inOf the teaching challenges that faculty reported being least structors. Such students may require as much tailoring of the prepared for, working with students who had learning, emotional, clinical learning environment as do academically or clinically and physical disabilities were selected most frequently. Particistruggling students to promote their higher level learning. Clinipants also indicated that these topics were less likely to be adcal faculty may benefit from exposure to teaching strategies addressed in their graduate education programs or continuing edudressing these student needs as well as to strategies addressing cation. According to the National Center for Education Statistics, weaknesses. TABLE
S40
Copyright © SLACK Incorporated
RESEARCH BRIEFS
Clinical Assignments and Strategies
Participants in this study identified the “classic” clinical instruction strategies of pre- and postclinical conferences, care plans, and chart review as those used most frequently with their students. There is a large and growing body of literature focused on educational methods to promote critical thinking in nursing students as well as in other health care profession students; such methods include the use of concept mapping, guided questions, and interdisciplinary rounds. These methods were not used often by the participants in this study. Phillips and Vinten (2010) suggest that different clinical teaching strategies are considered for use only when they are a good fit with the instructors’ values and beliefs, are easy to try, and seem better for student learning. Evidence supports a movement toward concept mapping to promote critical thinking, creative thinking, and holistic understanding of patient needs in nursing and other health care profession students (Daley & Torre, 2010; Huang, Chen, Yeh, & Chung, 2012; Sinatra-Wilhelm, 2012). Despite emphasis on the need for selection of best-practice mechanisms to promote and evaluate the development of critical thinking (Benner, Sutphen, Leonard, & Day, 2010), 81% of participants in this study reported still using nursing care plans as an evaluative assignment, and only 15% reported using care maps or other more innovative approaches to examine clinical concepts. Although the majority of instructors (58%) received information about critical thinking from their educational programs or through continuing professional development, few of the participants consistently used innovations such as guided questioning, despite its importance in the learning environment (Nickitas, 2012; Oermann, 1997). Cook, Dover, Dickson, and Colton (2012) argued that nursing care plans can be seen as a mechanism to communicate patient care needs, rather than the best way to assess students’ thinking and clinical decision-making skills.
Limitations These findings should be interpreted in the context of the study’s limitations. Because the convenience sample of participants was recruited from a professional development conference for nursing faculty, sampling bias is a possibility. In addition, the sample was small, and the participants were not queried about their highest level of education, years of experience in teaching, or their age, all of which might have an influence on the findings.
Conclusion Prelicensure nursing programs rely heavily on clinical faculty members to oversee student educational experiences in health care settings. Specific educational requirements for these instructors have not been clearly defined by nursing organizations that govern nursing programs. Continued research is required to gain a better understanding of the current and future educational needs of clinical faculty. These faculty will continue to face complex and challenging student issues, and will need the requisite skills required to address them appropriately.
References American Association of Colleges of Nursing. (2008). Preferred vision of the professoriate in baccalaureate and graduate nursing programs. Re-
Journal of Nursing Education • Vol. 53, No. 3, Suppl., 2014
trieved from http://www.aacn.nche.edu/publications/position/preferredvision Bartels, J.E. (2007). Preparing nursing faculty for baccalaureate-level and graduate level nursing programs: Role preparation for the academy. Journal of Nursing Education, 46, 154-158. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for transformation. San Francisco, CA: Jossey-Bass. Cangelosi, P.R., Crocker, S., & Sorrell, J.M. (2009). Expert to novice: Clinicians learning new roles as clinical nurse educators. Nursing Education Perspectives, 30, 367-371. Clark, C.M., Werth, L., & Ahten, S. (2012). Cyber-bullying and incivility in the online learning environment, part 1: Addressing faculty and student perceptions. Nurse Educator, 37, 150-156. Cook, L.K., Dover, C., Dickson, M., & Colton, D.L. (2012). From care plan to concept map: A paradigm shift. Teaching and Learning in Nursing, 7, 88-92. Dahlke, S., Baumbusch, J., Affleck, F., & Kwon, J.Y. (2012). The clinical instructor role in nursing education: A structured literature review. Journal of Nursing Education, 51, 692-696. Daley, B.J., & Torre, D.M. (2010). Concept maps in medical education: An analytical literature review. Medical Education, 44, 440-448. Davidson, K.M., & Rourke, L. (2012). Surveying the orientation learning needs of clinical nursing instructors. International Journal of Nursing Education Scholarship, 9(1), Article 3. Duke, M. (1996). Clinical evaluation—Difficulties encountered by sessional clinical teachers of nursing: A qualitative study. Journal of Advanced Nursing, 23, 408-414. Gardner, M.R., & Suplee, P.D. (2010). Handbook of clinical teaching in nursing and health sciences. Sudbury, MA: Jones and Bartlett. Hall, M.A. (2013). An expanded look at evaluating clinical performance: Faculty use of anecdotal notes in the U.S. and Canada. Nurse Education in Practice, 13, 271-276. Hewitt, P., & Lewallen, L.P. (2010). Ready, set, teach! How to transform the clinical nurse expert into the part-time clinical nurse instructor. The Journal of Continuing Education in Nursing, 41, 403-407. Huang, Y.C., Chen, H.H., Yeh, M.L., & Chung, Y.C. (2012). Case studies combined with or without concept maps improve critical thinking in hospital-based nurses: A randomized controlled trial. International Journal of Nursing Studies, 49, 747-754. Kelly, C. (2007). Student’s perceptions of effective clinical teaching revisited. Nurse Education Today, 27, 885-892. Luparell, S. (2007). The effects of student incivility on nursing faculty. Journal of Nursing Education, 46, 15-19. National League for Nursing. (2006). Position statement: Mentoring of nurse faculty. Nursing Education Perspectives, 27, 110-113. Nickitas, D.M. (2012). Asking questions and appreciating inquiry: A winning strategy for the nurse educator and professional nurse learner. The Journal of Continuing Education in Nursing, 43, 106-110. Oermann, M.H. (1997). Evaluating critical thinking in clinical practice. Nurse Educator, 22, 25-28. Phillips, J.M., & Vinten, S.A. (2010). Why clinical nurse educators adopt innovative teaching strategies: A pilot study. Nursing Education Perspectives, 31, 226-229. Ruland, J.P., & Leuner, J.D. (2010). Master’s programs preparing nurse educators: What is the current state of affairs? Nurse Educator, 35, 248-253. Scanlan, J.M., & Care, W.D. (2008). Issues with grading and grade inflation in nursing education. Annual Review of Nursing Education, 6, 173-188. Sinatra-Wilhelm, T. (2012). Nursing care plans versus concept maps in the enhancement of critical thinking skills in nursing students enrolled in a baccalaureate nursing program. Creative Nursing, 18, 78-84. Snyder, T.D., & Dillow, S.A. (2012). Digest of education statistics 2011 (NCES 2012-001). Washington, DC: National Center for Education Statistics. Sowers, J.A., & Smith, M.R. (2004). Nursing faculty members’ perceptions, knowledge, and concerns about students with disabilities. Journal of Nursing Education, 43, 213-218. Tanner, C.A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204-211. West, M.M., Borden, C., Bermudez, M., Hanson-Zalot, M., Amormin, F., & Marmion, R. (2009). Enhancing the clinical adjunct role to benefit students. The Journal of Continuing Education in Nursing, 40, 305-310.
S41
Nursing Faculty Preparedness for Clinical Teaching Patricia Dunphy Suplee, PhD, RNC-OB; Marcia Gardner, PhD, RN, CPNP, CPN; and Bonnie Jerome-D’Emilia, PhD, MPH, RN
ABSTRACT Nursing faculty who teach in clinical settings face complex situations requiring evidence-based educational and evaluative strategies, yet many have had limited preparation for these tasks. A convenience sample of 74 nursing faculty participated in a survey about clinical teaching in prelicensure nursing programs. Most faculty developed teaching skills through conferences (57%), orientation at their educational institution (53%), or exposure in graduate school (38%). Thirty-one percent reported having no preparation for clinical teaching. Faculty felt least prepared to manage students with learning, physical, or emotional disabilities and incivility. Twenty-six percent had no preparation for evaluating students in the clinical setting, and only 17% had worked with a faculty mentor. Few evidencebased teaching strategies were used by the faculty. These findings indicate gaps exist in the preparation of clinical faculty. Graduate education, comprehensive orientation programs, and continuing professional development may help to ensure faculty are effective in managing and evaluating student learning. [J Nurs Educ. 2014;53(3, Suppl.):S38-S41.]
C
linical experiences in prelicensure nursing education allow students to develop problem-solving skills and clinical judgment, to learn to “think like a nurse” (Tanner, 2006), under the guidance of nurse faculty. The diversity of students entering nursing, an emphasis on interdisciplinary health care practices, increasing complexity of clinical environments, and incorporation of high-fidelity simulation are changing the context of clinical teaching at a time when evidence-based nursing education strategies to support students’ learning are increasingly emphasized. Clinical faculty can be expert clinicians but may be inadequately prepared to manage a variety of clinical teaching challenges demanding targeted educational and evaluative strategies (Cangelosi, Crocker, & Sorrell, 2009; Hewitt & Lewallen, 2010; West et al., 2009). To better understand the extent of this problem, the aims of this study were to describe preparation for clinical instruction and the clinical instruction experiences of faculty who teach prelicensure nursing students, identify the range of student challenges that clinical faculty encounter and their level of comfort in managing these challenges, and describe available mechanisms for mentoring and professional development of clinical faculty.
Background
Received: August 18, 2013 Accepted: November 11, 2013 Posted Online: February 17, 2014 Dr. Dunphy Suplee is Assistant Professor, and Dr. Jerome-D’Emilia is Assistant Professor, Rutgers University, Camden; and Dr. Gardner is Associate Professor, College of Nursing, Seton Hall University, South Orange, New Jersey. The authors have disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Patricia Dunphy Suplee, PhD, RNC-OB, Assistant Professor, Rutgers University, 311 North 5th Street, Camden, NJ 08102; e-mail: [email protected]. doi:10.3928/01484834-20140217-03
S38
Preparation for clinical teaching in nursing ranges from brief orientations provided by the university or college employer to continuing professional development to degree-granting programs. Clinical faculty report having unmet needs for information about academic and clinical policies and procedures, curriculum and course content, student evaluation, and simulation (Davidson & Rourke, 2012). Dahlke, Baumbusch, Affleck, and Kwon (2012) concluded that instructors often lack formal academic or continuing education preparation in clinical education, hold a diversity of views on the clinical teaching role, and tend to use their personal experiences as clinicians and students in constructing their roles. Grading and clinical evaluation are challenges for clinical faculty, who report difficulty determining clinical grades and assigning failing grades, and maintaining subjectivity in evaluation (Duke, 1996; Hall, 2013; Scanlan & Care, 2008). Although the numbers of nurse educator programs at the certificate, master’s, and doctoral level are growing, there is no national expectation that faculty, in general, and clinical faculty specifically, have formal preparation in educational methods. Typically, the requirement for clinical teaching in prelicensure programs is a master’s degree in a clinical specialty, subject to Copyright © SLACK Incorporated
RESEARCH BRIEFS
variation according to states’ nurse practice acts (American Association of Colleges of Nursing, 2008; Bartels, 2007; National League for Nursing, 2006; Ruland & Leuner, 2010). There is no consensus and little evidence to support any one form of educational preparation as best for the clinical faculty role (Davidson & Rourke, 2012).
Method Nursing faculty from the northeastern United States attending a faculty development conference were recruited to participate. Inclusion criteria were having a current role as a nursing faculty member and either supervising clinical instructors or engaging in clinical teaching. The study was approved by the university’s institutional review board. Of the 135 conference attendees, 74 completed the surveys. This descriptive study used a researcher-developed 14-item questionnaire based on current nursing literature. The survey included Likert-type and openended questions. Data analysis was conducted with STATA® software using descriptive statistics and bivariate analysis.
to make clinical assignments (47%). Topics that faculty reported learning about the least included: how to work with students with physical disabilities (12%), how to work with excellent students (19%), how to work with students who have learning disabilities (22%), how to work with students with emotional disabilities (26%), and how to manage legally mandated student learning accommodations (26%). When asked which clinical instruction challenges they were least prepared to handle, 42% reported working with students with learning disabilities, 39% reported working with students with physical disabilities, 39% reported managing students with emotional disturbances, and 36% reported managing student incivility (Table). Faculty from BS/BSN programs were significantly less prepared to handle students who had physical disabilities (p = 0.04) compared to those from AD and diploma programs. Faculty from all schools were least prepared to manage accommodations mandated by the school’s disability policy; this association was statistically significant (p = 0.03). Clinical Teaching Situations
Results In this sample of nursing faculty, 30% taught in diploma programs, 55% taught in associate degree (AD) programs, and 15% taught in baccalaureate (BS/BSN) programs. Eighty-two percent of the participants directly taught students in the clinical setting, and 39% supervised clinical instructors in a nursing course. The majority of the participants (60%) taught in nursing programs with fewer than 200 students. Educational Preparation and Development
Fifty-seven percent of faculty had attended conferences to prepare for clinical teaching, 53% had received orientation to clinical teaching at their educational institution, and 31% reported no preparation for clinical teaching. Thirty-eight percent had formal education about clinical teaching during graduate education, and 17% were assigned a faculty mentor when learning the role. When asked how they were taught to provide students with effective feedback, 58% stated they received instruction from the course director or coordinator; however, 26% reported receiving no training on providing effective student feedback. Regarding faculty development activities to support improvement in clinical instruction, 49% of participants reported receiving an evaluation of their skills by the course director or coordinator, 46% were offered an opportunity to attend workshops, 28% were provided with reading materials, 32% received a peer evaluation, and 16% reported that their academic institutions did not offer any faculty development. Faculty in diploma and AD programs were significantly more likely to receive continued development (p = 0.02) compared to faculty who taught in BS/BSN programs. Significantly more AD and BS/BSN programs provided faculty with reading materials and online resources compared to diploma programs (p = 0.02).
Participants were provided with 26 different clinical teaching encounters extracted from reports in the literature, and they were instructed to rate the frequency of their occurrence. Faculty reported often/always encountering and having to manage highly anxious students (57%), highly prepared students (54%), students who met clinical objectives easily (48%), and students with poor calculation skills (47%). The clinical teaching situations that participants reported they were least likely to encounter and needed to manage included conflicts with an attending provider (1%), student errors in care (nonmedication) (4%), students who refused to sign performance evaluations (4%), and students who communicated inappropriately with other health care staff (4%). When reported encounters and student issues were analyzed by program type, faculty from all programs reported never/occasionally having encountered incivility or rudeness (p < 0.01) or inappropriate communication with other health care staff (p = 0.04). Faculty from diploma and BSN programs were significantly more likely to report having to manage students with poor calculation skills compared to those from AD programs (p = 0.01). Clinical Assignments and Teaching Strategies
Eighty-one percent of faculty members used care plans as a clinical assignment. Group presentations (60%) and papers (58%) also were used frequently by faculty during clinical experiences. Teaching strategies that faculty used on a regular basis included postconferences (89%), chart reviews (80%), preconferences (77%), giving and receiving report (68%), and observational experiences (66%). Teaching strategies that were least likely to be used on a regular basis by clinical faculty included games (16%), reviewing research reports (18%), and interdisciplinary rounds (23%).
Educational Knowledge and Skills
The clinical teaching topics that faculty most frequently reported learning about from their institution or through their advanced education included: how to document student progress (61%), how to teach students to think critically (58%), and how Journal of Nursing Education • Vol. 53, No. 3, Suppl., 2014
Discussion Many clinical instructors do not receive adequate training for this role. In fact, 31% of participants in this study reported having had no training whatsoever, 38% had exposure to inS39
RESEARCH BRIEFS
approximately 11% of students in higher education have a disability (Snyder & Dillow, Clinical Challenges Participants (N = 74) Reported as Being Least Prepared to Handle 2012). Sowers and Smith Type n (%) (2004) reported 72% of their sample of nursing faculty had Working with students with learning disabilities 31 (41.89) taught students with disabiliWorking with students with physical disabilities 29 (39.19) ties; of these, 60% reported Managing students with emotional disturbances 29 (39.19) teaching students with learnManaging student incivility 27 (36.49) ing disabilities, 25% reported teaching students with physiWhat to do with students who seem to “know it all” 23 (31.08) cal disabilities, and 28% reEvaluating students who may be “just getting by” 22 (29.73) ported teaching students with Managing conflicts with clinical unit staff 21 (28.38) mental health disabilities. Considering the likelihood Managing accommodations mandated by the school’s disabilities office 13 (17.57) that nursing faculty will enDeveloping a remediation plan for students who need improvement 13 (17.57) counter students with various What to do with “star” students 13 (17.57) disabilities, both educator Grading care maps or care plans 11 (14.86) preparation and continuing education programs should Overseeing medication administration with multiple students 11 (14.86) integrate more information Working with nurse preceptors 10 (13.51) about best educational pracDetermining whether students are adequately prepared for clinical assignments 9 (12.16) tices for this diverse populaWhat to do with students who never seem to participate 8 (10.81) tion of students. Although faculty reported Working with students who have made errors 8 (10.81) rarely encountering incivilGiving constructive verbal feedback 5 (6.76) ity, 36% reported difficulty Running pre- or postconferences 4 (5.41) when confronted with incivility, suggesting the need Giving constructive written feedback 4 (5.41) for additional information Selecting clinical assignments 3 (4.11) and guidance. Most research Working with students from diverse backgrounds 2 (2.70) on incivility in nursing eduCompleting a clinical rotation evaluation of students 1 (1.35) cation has focused on faculty who teach in the classroom or in an online learning environment (Clark, Werth, & formation or experiences related to clinical teaching in their Ahten, 2012; Luparell, 2007). It is encouraging to note that graduate programs, and slightly more than half of the study parfew faculty in this sample encountered student incivility in the ticipants received an orientation to teaching students. Twentyclinical environment, given that incivility in higher education, six percent of the sample reported that they had received no including nursing education, has been reported to be a comtraining on providing student feedback. Appropriate feedback mon occurrence. is important in the learning process, and giving feedback is a Student issues that faculty reported more often encountercritical component of clinical teaching and evaluation (Gardner ing and needing to manage included dealing with those students & Suplee, 2010; Kelly, 2007). who are highly anxious, are highly prepared, and have poor calGiven the importance of clinical learning for development culation skills. Such issues may demand that faculty use speof clinical judgment, more attention to the preparation of efcialized teaching strategies to enhance learning. It is important fective clinical teachers is warranted. It would be beneficial for for clinical instructors to be aware of assessment strategies that academic institutions employing or preparing nursing faculty will allow them to identify and address students’ specific learnto offer programs addressing some of the faculty challenges reing challenges and strengths. ported in this study. Students who are extremely bright, have exceptional critical thinking skills, or go above and beyond the expectations set Educational Challenges for the course can present additional challenges to clinical inOf the teaching challenges that faculty reported being least structors. Such students may require as much tailoring of the prepared for, working with students who had learning, emotional, clinical learning environment as do academically or clinically and physical disabilities were selected most frequently. Particistruggling students to promote their higher level learning. Clinipants also indicated that these topics were less likely to be adcal faculty may benefit from exposure to teaching strategies addressed in their graduate education programs or continuing edudressing these student needs as well as to strategies addressing cation. According to the National Center for Education Statistics, weaknesses. TABLE
S40
Copyright © SLACK Incorporated
RESEARCH BRIEFS
Clinical Assignments and Strategies
Participants in this study identified the “classic” clinical instruction strategies of pre- and postclinical conferences, care plans, and chart review as those used most frequently with their students. There is a large and growing body of literature focused on educational methods to promote critical thinking in nursing students as well as in other health care profession students; such methods include the use of concept mapping, guided questions, and interdisciplinary rounds. These methods were not used often by the participants in this study. Phillips and Vinten (2010) suggest that different clinical teaching strategies are considered for use only when they are a good fit with the instructors’ values and beliefs, are easy to try, and seem better for student learning. Evidence supports a movement toward concept mapping to promote critical thinking, creative thinking, and holistic understanding of patient needs in nursing and other health care profession students (Daley & Torre, 2010; Huang, Chen, Yeh, & Chung, 2012; Sinatra-Wilhelm, 2012). Despite emphasis on the need for selection of best-practice mechanisms to promote and evaluate the development of critical thinking (Benner, Sutphen, Leonard, & Day, 2010), 81% of participants in this study reported still using nursing care plans as an evaluative assignment, and only 15% reported using care maps or other more innovative approaches to examine clinical concepts. Although the majority of instructors (58%) received information about critical thinking from their educational programs or through continuing professional development, few of the participants consistently used innovations such as guided questioning, despite its importance in the learning environment (Nickitas, 2012; Oermann, 1997). Cook, Dover, Dickson, and Colton (2012) argued that nursing care plans can be seen as a mechanism to communicate patient care needs, rather than the best way to assess students’ thinking and clinical decision-making skills.
Limitations These findings should be interpreted in the context of the study’s limitations. Because the convenience sample of participants was recruited from a professional development conference for nursing faculty, sampling bias is a possibility. In addition, the sample was small, and the participants were not queried about their highest level of education, years of experience in teaching, or their age, all of which might have an influence on the findings.
Conclusion Prelicensure nursing programs rely heavily on clinical faculty members to oversee student educational experiences in health care settings. Specific educational requirements for these instructors have not been clearly defined by nursing organizations that govern nursing programs. Continued research is required to gain a better understanding of the current and future educational needs of clinical faculty. These faculty will continue to face complex and challenging student issues, and will need the requisite skills required to address them appropriately.
References American Association of Colleges of Nursing. (2008). Preferred vision of the professoriate in baccalaureate and graduate nursing programs. Re-
Journal of Nursing Education • Vol. 53, No. 3, Suppl., 2014
trieved from http://www.aacn.nche.edu/publications/position/preferredvision Bartels, J.E. (2007). Preparing nursing faculty for baccalaureate-level and graduate level nursing programs: Role preparation for the academy. Journal of Nursing Education, 46, 154-158. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for transformation. San Francisco, CA: Jossey-Bass. Cangelosi, P.R., Crocker, S., & Sorrell, J.M. (2009). Expert to novice: Clinicians learning new roles as clinical nurse educators. Nursing Education Perspectives, 30, 367-371. Clark, C.M., Werth, L., & Ahten, S. (2012). Cyber-bullying and incivility in the online learning environment, part 1: Addressing faculty and student perceptions. Nurse Educator, 37, 150-156. Cook, L.K., Dover, C., Dickson, M., & Colton, D.L. (2012). From care plan to concept map: A paradigm shift. Teaching and Learning in Nursing, 7, 88-92. Dahlke, S., Baumbusch, J., Affleck, F., & Kwon, J.Y. (2012). The clinical instructor role in nursing education: A structured literature review. Journal of Nursing Education, 51, 692-696. Daley, B.J., & Torre, D.M. (2010). Concept maps in medical education: An analytical literature review. Medical Education, 44, 440-448. Davidson, K.M., & Rourke, L. (2012). Surveying the orientation learning needs of clinical nursing instructors. International Journal of Nursing Education Scholarship, 9(1), Article 3. Duke, M. (1996). Clinical evaluation—Difficulties encountered by sessional clinical teachers of nursing: A qualitative study. Journal of Advanced Nursing, 23, 408-414. Gardner, M.R., & Suplee, P.D. (2010). Handbook of clinical teaching in nursing and health sciences. Sudbury, MA: Jones and Bartlett. Hall, M.A. (2013). An expanded look at evaluating clinical performance: Faculty use of anecdotal notes in the U.S. and Canada. Nurse Education in Practice, 13, 271-276. Hewitt, P., & Lewallen, L.P. (2010). Ready, set, teach! How to transform the clinical nurse expert into the part-time clinical nurse instructor. The Journal of Continuing Education in Nursing, 41, 403-407. Huang, Y.C., Chen, H.H., Yeh, M.L., & Chung, Y.C. (2012). Case studies combined with or without concept maps improve critical thinking in hospital-based nurses: A randomized controlled trial. International Journal of Nursing Studies, 49, 747-754. Kelly, C. (2007). Student’s perceptions of effective clinical teaching revisited. Nurse Education Today, 27, 885-892. Luparell, S. (2007). The effects of student incivility on nursing faculty. Journal of Nursing Education, 46, 15-19. National League for Nursing. (2006). Position statement: Mentoring of nurse faculty. Nursing Education Perspectives, 27, 110-113. Nickitas, D.M. (2012). Asking questions and appreciating inquiry: A winning strategy for the nurse educator and professional nurse learner. The Journal of Continuing Education in Nursing, 43, 106-110. Oermann, M.H. (1997). Evaluating critical thinking in clinical practice. Nurse Educator, 22, 25-28. Phillips, J.M., & Vinten, S.A. (2010). Why clinical nurse educators adopt innovative teaching strategies: A pilot study. Nursing Education Perspectives, 31, 226-229. Ruland, J.P., & Leuner, J.D. (2010). Master’s programs preparing nurse educators: What is the current state of affairs? Nurse Educator, 35, 248-253. Scanlan, J.M., & Care, W.D. (2008). Issues with grading and grade inflation in nursing education. Annual Review of Nursing Education, 6, 173-188. Sinatra-Wilhelm, T. (2012). Nursing care plans versus concept maps in the enhancement of critical thinking skills in nursing students enrolled in a baccalaureate nursing program. Creative Nursing, 18, 78-84. Snyder, T.D., & Dillow, S.A. (2012). Digest of education statistics 2011 (NCES 2012-001). Washington, DC: National Center for Education Statistics. Sowers, J.A., & Smith, M.R. (2004). Nursing faculty members’ perceptions, knowledge, and concerns about students with disabilities. Journal of Nursing Education, 43, 213-218. Tanner, C.A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204-211. West, M.M., Borden, C., Bermudez, M., Hanson-Zalot, M., Amormin, F., & Marmion, R. (2009). Enhancing the clinical adjunct role to benefit students. The Journal of Continuing Education in Nursing, 40, 305-310.
S41
