“The job of the teacher is, as it has always been, to make learning so compelling that people find it more satisfying to learn than to attend to any one of the score of competing possibilities.” – Carol Ann Tomlinson, EdD, professor and chairwoman of educational leadership, foundations and policy at the University of Virginia’s Curry School of Education.”1

teaching-1Behind every good nurse is an inspirational educator — or perhaps many. As gatekeepers who ensure safe nursing practice, faculty members have a rich history of providing knowledge, teaching essential skills and inspiring students to set high standards for patient care. Today’s faculty faces unparalleled challenges as they prepare students for increasingly complex nursing roles in a rapidly changing world.

This module discusses innovative approaches educators use to meet the challenges of transforming education and preparing nurses who will succeed in this millennium. It also describes forces driving changes in nursing and nursing education, how faculty meet the learning needs of diverse students, and the rewards and challenges of being a nurse educator.

Not Your Mother’s Program

Gone are the days of sitting in three-hour lectures trying to stay awake after pulling an all-nighter. Educators today work to promote meaningful, interactive learning by using a variety of strategies. From using technology to designing collaborative learning experiences that focus on “real world” issues, educators aim to ensure that their students remain engaged in learning every step of the way.

Technology Impact

Not surprisingly, technology affects what happens in today’s classrooms. Laptops, iPads, smart phones, Web-based videos, webinars and other uses of the Internet are commonplace.2 Many programs use e-learning management systems, such as Blackboard. These systems let faculty members give online examinations and quizzes, use software to identify plagiarized papers, and post resources for reinforcement and enrichment. Students have easy access to materials and information, such as grades, lecture materials, readings and syllabi. Students also use handheld remote devices, clickers, to let the instructor know immediately how well they understand a lecture. (With clickers, students key in answers to quizzes given during lectures. The instructor has a receiver device through which he or she can see immediately how many students passed the quiz.) In addition, many instructors record lectures so students can listen to them on their iPods or smart phones.

Online discussion boards allow students to post assignments and information for classmates and faculty. The ability to share information promotes great online discussions and allows constructive peer evaluation. Blogs (online personal journals) facilitate peer support and can document individual reflections on courses for faculty review. Wikis, collaboratively constructed websites that allow content to be added and edited, are used by students to share information and work together on reports and projects.2 Interactive teaching strategies using computer-based instruction — including computer-assisted instruction, computer simulations, interactive video instruction and tutorials — promote active learning. Technology also affects students’ clinical learning. Students use smart phones and personal digital assistants to access information about disease processes, evidence-based nursing, and drug and treatment information.

Creating Learning Cultures

Increasingly, schools today are accountable for creating a learning culture that embraces the motto that “everyone teaches, everyone learns.” Building learning cultures —school and work environments that encourage learners and employees at all levels to ask questions, share information freely, and create teaching/learning opportunities— is the foundation for developing critical thinking, improving outcomes and keeping patients safe.3

Concept-Based Curriculum

Responding to the call for education reform, many schools of nursing are considering changing to a concept-based curriculum.4 Concept-based curriculums aim to promote critical thinking and reduce content overload by teaching big ideas that can be transferred from one situation to another. For example, a student in a concept-based curriculum may learn the concepts of oxygenation and inflammation in adult nursing, and then when they get to pediatrics, discuss how these change in children’s bodies. In the past, content focused on facts. Concept-based curriculums focus on making sense of those facts. Faculty can’t possibly teach everything, but they can teach the big ideas. Content can change. Concepts stay the same.

Successful implementation of concept-based curriculums requires educators to transform learning from traditional teacher-focused delivery of information to student-centered teaching in which students are engaged actively in learning. As part of curriculum development, faculty must select the concepts, competencies and exemplars on which to build courses and base content. Then they must organize the concepts in a way that facilitates learning. This is challenging intellectually, and takes a lot of work and a commitment to making changes.

Simulation and Debriefing

With the use of high-fidelity human simulators — life-like mannequins that mimic many of the human body’s processes, such as heart rate and blood pressure — the worlds of laboratory and clinical learning merge. Using simulators, students can practice complex assessment skills, and hone their ability to set priorities, make decisions, and take appropriate action when things go wrong. Simulated experiences offer a controlled-learning environment and provide students with immediate feedback, allowing for self-correction and remediation if needed.2,3,5 Students learn from their own mistakes, which is a powerful way to learn, in a safe environment. When well-designed simulated experiences are followed by debriefing on what went well and what could be done better, students learn to manage common clinical issues before they care for real patients.2,3,5

Problem-Based Learning and Flipped Classrooms

Problem-based learning is another educational process that engages students actively. With problem-based learning, the teacher presents a patient scenario to a small group of students and asks the group to decide what information is needed to address the patient’s issues. Group members pair off to conduct an independent inquiry that they later share with the group. A faculty member serves as a learning facilitator and guide.6

To increase student engagement, some faculty use a “flipped classroom” (time allotted for lecture and homework is reversed).7 In a flipped classroom, students learn content online before coming to school, and then they do homework in class, with teachers and students discussing and solving questions together. Teacher interaction with students is more personalized, and guidance is used instead of lecturing. While some teachers believe the flipped classroom is more engaging, school’s still out (pardon the pun) on how well it works. A study that aimed to determine the effects of a flipped classroom found that examination scores were higher for students in flipped classrooms than those in traditional lecture classes. But students in flipped classrooms indicated lower satisfaction with learning than those in the lecture classes.7 You can find informative YouTube videos on how to flip the classroom by entering “flipped classroom” in to the search field at http://www.youtube.com.

More Diverse Than Ever

Classrooms today are full of students who are ethnically diverse. Faculty must know how to reach out to all their students equally. There are also more men in nursing than ever before. Because of their socialization, some men may have a different, but valid, approach to particular elements of nursing.3 For example, some men have a harder time expressing emotion and may not establish therapeutic relationships with patients in the same way that most female nurses do. Men may be more likely to use humor and less likely to use touch. Based on their female expectations for communication, women may view this way of relating as inattentive and nontherapeutic.3 You can learn more about issues facing men in nursing and education on the American Assembly for Men in Nursing website. The organization provides a framework for nurses as a group to meet, discuss and influence factors that affect men as nurses.

Faculty members also face the challenge of meeting learning needs of students from different generations. A generation refers to a group of people who share birth years and have lived through the same significant events. The beliefs, culture and values of each generation are shaped by historical, political and social events that occur during the formative years of its members.6 Although there are individual differences, members of one generation tend to view the world differently than members of other generations. For example, members of the baby boom generation, born between 1946 and 1964, grew up in a time of post-World War II optimism and unparalleled economic growth. Baby boomers are sometimes described as “living to work,” and work has significant meaning in their lives. In today’s nursing programs, baby boomers are mature students who may be returning to college or completing a second degree.8 Because baby boomers didn’t grow up with technology, they may prefer to learn through more traditional teaching methods.6

Generation X, born between 1964 and 1981, had different life experiences as children. Generation Xers grew up during a time of rising divorce rates, rapid movement of women into the workforce and a faltering economy. Many members of this generation were “latchkey” children while both parents worked. As a group, members of Generation X are self-reliant and resourceful, and are sometimes described as “working to live.” In general, they want to learn content in a quick and direct way.8 Most faculty members are baby boomers or Generation Xers, and are familiar with the learning styles of students from these generations.

The Newest Generation

Meeting the learning needs of nursing’s newest generation, the Millennials (those born after 1981), is a challenge.8 They have characteristics different than those of students of previous generations. Millennials share two key life experiences that affect how they view the world: intensive parental involvement during their formative years and the technology revolution that occurred during their childhood. Members of this generation have led highly structured lives that were organized and supervised by adults. As a result, they may need support in balancing the demands of a nursing program. Technology is their native language; they are comfortable with multitasking and switch easily from completing an assignment, listening to their iPods, writing or reading a blog, texting friends and talking on their cell phones.8 As children, they participated in interactive computer activities and are often more comfortable getting information from the Web than from a library. In general, they prefer active and engaging activities, such as simulations and group work, rather than lectures.8

Join the Ranks

Being a nurse educator is unlike any other role. Nursing faculty must prepare students for nursing practice while providing them with knowledge they will need to pass state licensing examinations. Becoming a nursing faculty member requires education, experience and the desire to share knowledge with others. Most nursing programs seek faculty members who are educated at least one level higher than the students they will teach, with most requiring a master’s degree. In a BSN program, both full- and part-time faculty must have at least a master of science degree in nursing; a doctoral degree is generally required for appointment to tenure track at most schools of nursing. Many nurse educators take the certified nurse educator examination to verify their qualifications.

What Makes a Great Teacher?

A study that asked students to name the traits of a great nursing educator showed that the ideal instructor is approachable, a good communicator, professional, supportive, understanding, motivating, receptive to people and ideas, has a sense of humor, and is dedicated to teaching nursing.9 Overall, students described the best faculty members as being those who respected them as people and who were professional role models.

Effective educators are knowledgeable about generational and learning style differences and tailor learning activities accordingly. They make links between theory and practice, teach simple concepts before complex ones, give constructive feedback and build trusting relationships with students.10 You can find more information on what makes a great nurse educator at the links below.

  • 10 qualities of a great nurse educator
    http://nursinglink.monster.com/education/articles/9337-10-qualities-of-a-great-nurse-educator
  • Top 10 qualities of a great nurse educator
    http://scrubsmag.com/10-qualities-of-a-great-nurse-educator/

Challenges and Rewards

Nursing faculty members experience their own challenges and rewards. Factors that influence faculty to teach in a particular nursing program or to stay in one include the philosophical tenets of the college or university, the organizational culture of the faculty and student diversity. Working in an intellectually stimulating environment, having autonomy, contributing to the profession and having work flexibility are all important benefits for nurse educators.8 To encourage nurses to become nurse educators, the National League for Nursing has developed a list of the top 10 reasons to become a nurse educator.

One researcher found the following important experiential themes among both novice and experienced full-time faculty in a BSN program:11

  1. The most rewarding part of the role was the sense among faculty that they were “making a difference in students, the profession and the world.” They described the gratification they felt by being instrumental in students’ success while also feeling that student accomplishments were their successes.
  2. The sense of accountability faculty members have to nursing as “gatekeepers of the profession.” Evaluating who will be ethical, caring nurses is a critical faculty task.
  3. The challenges of trying to balance multiple roles. Nursing faculty members are not only responsible for teaching, but are also expected to keep their practice skills current, participate in research and community service, and work with others in curriculum development and committee work. Balancing these roles with a personal life was another part of this theme, as was the need for support and mentoring, especially as new faculty members.

Faculty members’ earning less than their nursing peers in clinical positions and the lack of support for role orientation and growth are often reported as problems. The National League for Nursing (NLN), the American Association of Colleges of Nursing (AACN) and other groups involved in supporting nursing faculty are working to address these issues.

Current and projected faculty shortages threaten nursing education, nursing’s future and ultimately patient care. The 2014 annual AACN report confirmed that growth in U.S. schools of nursing is restrained by a faculty shortage, which is driven by a limited pool of doctoral-prepared nurses and noncompetitive faculty salaries.12 Based on data from 680 schools of nursing with baccalaureate and graduate nursing programs, the nursing faculty vacancy rate in 2013 was 8.3%. The large majority of reported vacancies (86.9%) are for faculty positions requiring or preferring a doctoral degree. To address these issues, the AACN report calls for collaboration, innovation and leadership to address nursing education issues.

Safeguarding the Future

With a looming nursing shortage, recruiting, compensating and retaining the best nurse educators are vital for the profession’s future.13 There is a particular need for nurses from minority groups to become nurse educators. Seventy-five percent of current nursing faculty members are expected to retire by 2019, creating tremendous opportunities for those who want to become full- or part-time nurse educators.13 Federal and state governments are developing scholarships and loan repayment programs to attract graduate nursing students as faculty members. The NLN website contains excellent information about the nurse educator role and provides information about scholarships and loans. There is the Simulation Innovation Resource Center, where faculty can learn to develop and integrate simulations into the curriculum, as well as professional development courses for both seasoned and new educators.

The AACN’s Minority Nurse Faculty Scholars Program offers information about financial support for graduate nursing students from minority backgrounds who agree to teach in a nursing program after graduation. You can find other financial aid from the AACN at http://www.aacn.nche.edu/students/financial-aid.

At the Crossroads

The goal of providing safe, evidence-based and cost-effective healthcare is driving change in the healthcare industry. Nurses are crucial to this process because they’re the ones on the front line, assessing patients’ health status, monitoring and evaluating responses to treatment, providing direct care and teaching patients to manage complex healthcare problems.

Experts inside and outside healthcare have raised issues that are affecting significantly how nursing care is provided and how future nurses will be educated. The Institute of Medicine (IOM) report “To Err is Human: Building a Safer Healthcare System” was a wake-up call for both healthcare providers and consumers.14 The report estimated that as many as 98,000 Americans die each year of largely preventable medical errors and concluded that the goal of reducing harm to patients will be reached by developing a culture of safety in healthcare organizations and by changing the way healthcare professionals are educated.

The implications of the IOM’s report for nursing education (“Teaching IOM: Implications of the Institute of Medicine Reports for Nursing Education”) reinforce the need for undergraduate and graduate nursing students to be better prepared to develop and implement policies and practices that reduce harm and improve quality.15 This report outlines several key patient care concerns for which nurses must provide leadership. Although providing direct physical care is the most visible nursing role, other roles — such as monitoring patient status, helping patients compensate for functional loss, providing emotional support, educating patients and families, and integrating and coordinating care — are equally important to ensure consumers safe, high-quality, cost-effective healthcare. Work is in progress to guide curricula to prepare students for future nursing roles.

The AACN documents key competencies for BSNs. These competencies address the need for graduates to be able to use evidence-based practice, ensure patient safety, use clinical reasoning, work as members of an interprofessional team, and have a basic knowledge of genetics and genomics. The NLN posts both competencies for nursing program graduates and nurse educators.

Nurse educators responded to the IOM reports by developing the Quality and Safety Education for Nurses project. The QSEN goal is to prepare future nurses to gain the knowledge, skills and attitudes needed to continually improve the quality and safety of the healthcare system.16 This includes integrating the following competencies into nursing education:16

  • Patient-centered care: Recognize that patients or their designees must be the source of control. Make them full partners in giving compassionate and coordinated care based on respect for their preferences, values and needs
  • Teamwork and collaboration: Function effectively within nursing and inter­professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care
  • Evidence-based practice: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare
  • Quality Improvement: Use data to monitor the outcomes of care processes, and use improvement methods to design and test changes continually to improve the quality and safety of healthcare systems
  • Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance

You can find many resources for teaching the QSEN competencies and using various teaching strategies at its website.

Radical Transformation

The national study “Educating Nurses: A Call for Radical Transformation,” is expected to have a significant impact on nursing education.17 Sponsored by the Carnegie Foundation for the Advancement of Teaching in collaboration with the NLN, AACN and National Student Nurses’ Association, this publication is the first national study of nursing education in 30 years. It examines the strengths and weaknesses of contemporary nursing education, describes the most effective ways of teaching nursing students and calls for major changes in the way future nursing students will be educated.18

The study concluded that nurses are undereducated for the demands of practice and that it’s increasingly difficult for nursing education to keep ahead of rapid changes driven by research and technology. Among the report’s most significant recommendations are to 1) improve the integration of theory with clinical practice; 2) use active learning strategies with a focus on exemplars (i.e., accounts of skilled nursing practice) and case studies to improve clinical reasoning; 3) support nursing faculty in augmenting their teaching skills; and 4) increase faculty compensation.

The Carnegie report urges educators to provide as many experiences as possible to allow students to practice clinical reasoning and multiple ways of evaluating and responding to patient needs as clinical situations evolve. Nursing faculty members should see themselves as learning coaches and mentors rather than as providers of content, a role that’s increasingly described as going from “sage on the stage” to “guide on the side.”

Nurse educators have the opportunity to pass on their passion for nursing and desire for great patient care and lifelong learning to all those whose lives they touch. We all can remember a faculty member whose personal qualities continue to influence our practice. Opportunities abound for those who want to help shape nursing education.teaching-2

EDITOR’S NOTE: Maureen Habel, MA, RN, is the original author of this educational activity, but has not had an opportunity to influence the content of this current version. Ann Kim, MSN, MPH, RN, CNS, and Nancy Schoofs, PhD, RN, are past authors of this educational activity, but have not had an opportunity to influence the content of this current version.

OnCourse Learning guarantees this educational activity is free from bias.

Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, is president of Teaching Smart/Learning Easy in Stuart, Fla. (http://www.AlfaroTeachSmart.com). She’s known nationally and internationally for her books and programs on teaching critical thinking and improving personal and professional performance.

References

1. Tomlinson C. Forward. In: Erickson H. Concept-Based Curriculum and Instruction: Teaching Beyond the Facts. Thousand Oaks, CA: Corwin Press:viii; 2002.
2. Thompson BW. The connected classroom: using digital technology to promote learning. In: Billings DM, Halstead JA. Teaching in Nursing: A Guide for Faculty. 5th ed. St. Louis, MO: Elsevier-Mosby. In press.
3. Alfaro-LeFevre R. Critical Thinking, Clinical Reasoning and Clinical Judgment: a Practical Approach. 6th ed. Philadelphia, PA: Elsevier-Saunders. In press.
4. Giddens J. Caputi L, Rodgers, B. Mastering Concept-Based Teaching: a Guide for Nurse Educators. St. Louis, MO: Elsevier-Mosby; 2014.
5. Pauly-O’Neill S. Simulation basics: getting ready for the real thing. Nurse.com Web site. http://ce.nurse.com/course/ce664/simulation-basics. Accessed April 22, 2015.
6. McMahon M, Christopher K. Case study method and problem-based learning: utilizing the pedagogical model of progressive complexity in nursing education. Int J Nurs Educ Scholarship. 2011;8:Article 22. doi: 10.2202/1548-923X.2275.
7. Missildine K. Fountain R, Summers L, Gosselin K. Flipping the classroom to improve student performance and satisfaction. J Nurs Educ. 2013;52(10):597-599. doi: 10.3928/01484834-20130919-03.
8. Halfer D, Saver C, Alfaro-LeFevre R. Bridging the generation gaps. Nurse.com Web site. http://ce.nurse.com/course/ce478/bridging-the-generation-gaps/. Accessed April 22, 2015.
9. Wieck K. Faculty for the millennium: changes needed to attract the emerging workforce into nursing. J Nurs Ed. 2003;42(4):151-158.
teaching-3 10. Tagliareni M. Nursing education needs you. Lippincott’s Nursing Center.com Web site. http://journals.lww.com/ajnonline/fulltext/2009/01001/nursing_education_needs_you.3.aspx. Accessed April 22, 2015.
11. Gaza E. The experience of being a full-time nursing faculty member in a baccalaureate nursing education program. J Prof Nurs. 2009;25(4):218-226. doi: 10.1016/j.profnurs.2009.01.006.
12. American Association of Colleges of Nursing. Building a Framework for the Future (2014 annual report). American Association of Colleges of Nursing Web site. http://www.aacn.nche.edu/aacn-publications/annual-reports/AnnualReport14.pdf. Accessed April 22, 2015.
13. Malone B. Testimony of the National League for Nursing: FY 2008 appropriations for Title VIII: nursing workforce development programs. Subcommittee on Labor, Health and Human Services, Education and related agencies committee on appropriations. US House of Representatives, March 29, 2007. National League for Nursing Web site. http://www.nln.org/docs/default-source/advocacy-public-policy/ceo_testimony.pdf?sfvrsn=2. Accessed April 22, 2015.
14. Kohn L, Corrigan J, Donaldson M, eds. Committee on Quality Healthcare in America, Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000. National Academies Press Web site. http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx. Accessed April 22, 2015.
15. Finkelman A, Kenner C. Teaching IOM: Implications of the Institute of Medicine Reports for Nursing Education. 3rd ed. Silver Springs, MD: American Nurses Association; 2013.
16. Quality and Safety Education for Nurses (QSEN) goal statement. QSEN Web site. http://qsen.org/about-qsen. Accessed April 21, 2015.
17. Benner P, Sutphen M, Leonard V, Day L. Book highlights from Educating Nurses: A Call for Radical Transformation. The Carnegie Foundation for the Advancement of Teaching Web site. http://www.carnegiefoundation.org/elibrary/educating-nurses-highlights. Accessed April 22, 2015.
18. Schmidt P. Carnegie Foundation calls for ‘radical transformation’ of nursing education. Chronicle of Higher Education Web site. http://chronicle.com/article/Carnegie-Foundation-Calls-for/63443. Published January 6, 2010. Accessed April 22, 2015.