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Who Will Teach Our Nurses?

Throughout the world, nurses are called on to work in healthcare settings that are undergoing reform never before imagined.1 Patient needs and care delivery systems are more complex than ever. To give high-quality care, nurses must broaden their practice scope, master technology and information management systems and coordinate care across teams of healthcare professionals.1 Educators must prepare nurses to enter a workforce that’s complex, uncertain and constantly evolving. According to the National League for Nursing, nurses must recognize that “a critical goal for the future is to endorse academic progression options for all nurses.”1

Not only do the qualifications of the current nursing workforce need to be updated, the Health Resources and Services Administration projects that we’ll need more than 1 million new RNs by 2020.2 The good news is that nursing program applicants, enrollments and graduates have increased. The bad news is that despite increased enrollments, too many qualified applicants are being turned away from entry-level nursing programs, mostly due to faculty shortages.3

Some experts believe that even if colleges and universities could produce enough nurse educators to teach students on admission waiting lists, the problem still wouldn’t be solved. The prospect of not having enough nurses to meet the demand is now high on the radar for government and healthcare organizations. It makes many of us wonder: Who will be there to take care of me when I need it?

Safety and Science Endangered

Ever since an Institute of Medicine (now called the Health and Medicine Division [HMD] of the National Academies) study found that as many as 98,000 people die each year as a result of hospital stays – primarily from medical errors and hospital-acquired infections – patient safety has become a top priority.4 The role nurses play in monitoring patients to reduce adverse outcomes significantly affects preventable complications and deaths.4,5 As University of Pennsylvania researcher Linda Aiken points out, there’s a growing body of evidence to suggest a more highly educated nursing workforce saves lives. According to Aiken, “Our research shows that each 10% increase in the proportion of nurses in a hospital with a bachelor’s degree is associated with a 7% decline in mortality following common surgery.”6 A summary of Aiken’s research is available.7

To create safer hospitals, an adequate number of well-prepared nurses must be available. In 2010, the HMD shook up the nursing field when it called for 80% of all nurses to hold BSN degrees by 2020.8 As a result, there’s been an increase in RN-to-BSN programs requiring additional qualified faculty.9

The nursing shortage – the nursing faculty shortage in particular – not only threatens patient care, but also advances in nursing science. As a profession, nursing is still young. It’s only in the past few decades that nurse scholars and researchers have developed a scientific body of knowledge that promotes evidence-based practice. For nursing to fulfill its mission, these efforts must continue and expand. Nursing must have enough educators to prepare the next generation of nurses and enough researchers and scholars to continue to advance nursing science. The nursing field needs skilled educators who are qualified to do the studies needed to answer questions about how students learn and what teaching strategies are most effective. Recruiting more nurses into academic roles is crucial to doing the research to answer these questions.

The following forces drive the nursing faculty shortage:2,3

  • More faculty are nearing retirement.
  • The number of younger faculty has dropped.
  • More opportunities exist outside of academia.
  • There is a disparity between faculty and clinical salaries.
  • There are financial barriers, including tuition costs, student loans and lost income while in graduate school.
  • There are older doctoral recipients, leading to shorter careers in teaching.
  • Faculty workload demands and role expectations can lead to job dissatisfaction.

What It Takes

Being a nurse educator takes a passion for quality patient care, high-practice standards, a commitment to lifelong learning, creativity, flexibility and excellent communication and critical-thinking skills. It also requires a sincere desire to help students grow and develop. If you have these qualities or are willing to develop them, consider acquiring the educational background that will prepare you as a nurse educator. The nurse practice act in each state determines the qualifications nurse educators need. Some nurse practice acts distinguish between the academic qualifications of instructors who conduct clinical teaching and those who provide both classroom and clinical instruction. Accrediting agencies, such as the National League for Nursing (NLN) and the American Association of Colleges of Nursing (AACN) require full-time faculty to have doctoral degrees.

Nurse educators with master’s degrees (which are generally required) begin their teaching careers as junior faculty, instructors or assistant professors. Many of today’s students continue to work while they study part time, and most graduate programs accommodate the needs of working nurses. Students in master’s programs usually have bachelor’s degrees in nursing. Some graduate programs offer BSN-to-PhD programs and others have a generic master’s program for students with a non-nursing bachelor’s degree. In these innovative programs, students move through courses at an accelerated pace. Many graduate programs require applicants to have a 3.0 undergraduate grade point average, and some require desirable scores on the graduate record examination (GRE). Most schools require faculty to have doctoral preparation to be eligible for promotion to associate professor or full professor. In addition to teaching students, faculty members are often expected to demonstrate expertise in clinical practice, service, publishing, leadership, and research. Nurse educators fill positions ranging from adjunct (part-time) clinical faculty to deans of colleges of nursing. Students come from a variety of backgrounds, ranging from recent high-school graduates, to students with previous non-nursing careers to practicing nurses.

Usually, nursing faculty teach courses that correspond with the focus of their graduate nursing education program (e.g., adult, pediatric, psychiatric, obstetrics, critical care or community health nursing). Some faculty members also teach in areas in which they have evolved as specialists through academic preparation or personal study or experience (e.g., nursing leadership or healthcare management). Whatever the clinical or professional specialty area, nurse educators are first and foremost teachers and must be skilled in teaching strategies, evaluation of learning outcomes and curriculum development. They must know how to guide learners to reach their full potential.

No Ivory Tower

Some clinicians think nurse educators work in an ivory tower detached from nursing’s real world. Nothing could be further from the truth. To be effective teachers, nurse educators must devote time to remaining clinically competent and aware of new developments in nursing practice and research. The number of hours faculty devote outside of regular work time to do that can be formidable. One study found that two-thirds of faculty report a workload that exceeds what they expected in an academic role.10

Teaching is challenging but rewarding from professional and personal perspectives, as noted in the NLN’s Top 10 Reasons to Become a Nurse Educator.10

To find personal stories about the rewards of being a nurse educator, search the Internet for “Great Moments in Teaching Nursing.”

Nursing faculty members shape the knowledge and practice of new nurses on a grand scale. Many nurses remember the influence that nurse educators had on them by the way they practice nursing every day. As clinicians, we are responsible for our own practice and have control over the care we provide. Nurse educators have the opportunity to directly influence ways in which diverse generations of nurses work together to provide care.

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

Traditionally, nursing students have been a homogenous group. Most were young women who entered nursing programs immediately after high school. In contrast, 21st-century nursing students are a diverse group. There are more men in nursing today and more minority students, making knowing how to work with diverse students a crucial educator competency. In general, students are older than recent high school graduates and can be anywhere from their late 20s to their 50s and beyond. They are usually financially independent, bring work and life experiences to the academic setting and strive to balance their studies with job and family responsibilities.

Today’s educators know things have changed. One of the most significant changes in nursing education is the increase in online and distance learning programs. Faculty must be tech-savvy and know how to teach and evaluate students they don’t often see in the classroom. Another significant change is in the skills labs. Nurses have moved from using crude, plastic patient models to using high-fidelity human patient simulators. These lifelike simulators give students a realistic experience that mirrors what happens with real patients in the clinical setting. Human patient simulators allow students to recognize and respond to real-life situations. Instructors can build in scenarios for important bedside nursing care issues and introduce potential errors in care so students can learn the results of their actions in a controlled environment rather than in the hospital setting. No learning is more powerful than learning from your own mistakes.

What Students Want

Today’s students expect coursework to be practical, relevant and tailored to their needs. Often, classes are at satellite locations and scheduled one day a week or in the evening or on weekends to accommodate student work schedules. To meet students’ needs, nurse educators must be knowledgeable, creative and able to design educationally sound learning. They must know how to coach students, be mentors and apply evidence-based approaches to evaluating competencies. Many faculty members use new learning technology altering traditional classroom-based education and make it possible for learning opportunities to occur in various ways (e.g., service learning, interactive video conferencing and standardizing didactic information across several sites). Today’s students are more tech-savvy and have 24/7 access to resources, such as the library and their instructors. Many students juggle family and work obligations with school work, often feeling overwhelmed and needing the support and flexibility of their educators.

Changes on the Horizon

While much of nursing still occurs in hospitals, the profession is on the verge of a major transformation. In the past, nursing focused on taking care of dependent, ill people who were told, “We’ll take care of you…we know what’s best for you and you should do as we tell you.” Soon, many illnesses now treated in intensive hospital settings will be detected and prevented in their early stages. Nursing’s focus will be on including patients as partners in care and helping them make decisions about what’s best for them as individuals. Now nurses are learning to tell their patients, “You know yourself best; tell me what’s most important to you” and “I want to teach you how to manage your health so you know what do when I’m not here.” Major nursing responsibilities include counseling, teaching and guiding people to achieve and maintain optimum health.

At the same time the “what” of nursing is changing, the “how” of nursing education is also changing. Nurse educators are being asked to develop courses on bioterrorism, care for the elderly and vulnerable, genetics, health economics, health politics and policy, mass casualty response, palliative and end-of-life care and patient-care management. These and other topics prepare 21st-century graduates to practice in a dynamic and unpredictable healthcare climate. Students in nursing programs today enter an increasingly fast-paced, competitive and business-oriented environment. Students need to learn how to provide care in multiple settings with diverse groups of patient populations. They must know how to set priorities, as today’s nurses know all too well that not every patient need can be met.

The NLN and other organizations, such as the Quality and Safety Education in Nursing Institute, stress that significant changes in nursing and nursing education are on the horizon. Educators need to have specific competencies to transform nursing education to maximize student potential and help each student develop competencies that promote professional practice in a dynamic healthcare arena (see side bar).12,13 Many nurse educators today distinguish themselves by passing the NLN’s certified nurse educator exam, allowing them to put the credentials CNE after their name.14 As the need for leadership and research in nursing education is clear, there’s also a need for more doctorally prepared educators (calling for more qualified educators to teach in doctoral programs as well).15

Never Boring

Today’s nurse educator will never be bored. The days of preparing lectures and standing in front of the classroom giving those lectures day in and day out are gone. Instead, nurse educators are working collaboratively with their students. From their first semester of school, students are taught how to be active participants in all learning. Because today’s schools and organizations realize the importance of creating learning cultures where everyone teaches and learns, and learning opportunities are considered an important part of each day in the classroom, clinical and simulated learning is often lively and full of shared experiences.

If you feel intimidated by the preparation educators must do to teach a course, you needn’t be. You’ll get help from fellow educators and also find you have many resources to help ease the time-consuming work of making course content come alive. For example, many publishers give their textbook users free, professionally developed PowerPoints and test banks. They also provide online tutorials, case scenarios and videos to facilitate and reinforce learning. There are many online resources, such as YouTube, Google, and Google Scholar, where faculty post PowerPoint presentations, lectures, activities, illustrations, clinical demonstrations and videos from experienced educators. Teaching and learning today is easier than it used to be and more vibrant and fun.

Sneak Preview

If you’re up to the challenge of an academic career, start by looking for ways to experience the joys and challenges of what today’s educators do. Seek out opportunities in your organization to precept or mentor new staff or nursing students and assess the rewards you gain. Volunteer to develop and teach in-service programs, so you can begin to experience the exciting work of reviewing nursing literature, evaluating directions for evidence-based practice and communicating new developments to your colleagues. Talk to nursing faculty members who bring students to your agency — ask them about what they find most satisfying about their work. Contact experienced educators through social media (e.g., join nurse educator groups on LinkedIn to find an educator). Discussing the challenges related to being a new (or seasoned) educator is lively and informative. Many students use the virtual nurse educator community to get practical advice and to help find resources. It’s not unusual to read something like, “I’m thinking of becoming a nurse educator … any advice?”

After deciding a teaching career is for you, the next step is to locate a graduate program that fits your needs. Fortunately, finding information about nursing education careers and graduate programs is easier than ever, thanks to the Internet. (See “Educational and Financial Resources” sidebar.) The AACN sponsors Career Link, an online resource that features nurse educator career profiles, a list of programs that prepare nursing faculty, financial aid information, open faculty positions and links to faculty development programs. Federal and private funding are often available to help nurses who are enrolling in graduate nursing education.

Easing the Loan Load

The Nurse Reinvestment Act includes a student loan repayment program for nurses who agree to serve as faculty after graduation.16 In addition to developing an awareness of nurse educator careers and its rewards, the American Nurses Association and the AACN have been working to gain increased federal support for the Faculty Loan Repayment Program. This program, sponsored by the U.S. Department of Health and Human Services, offers up to 85% of loan cancellation for nurses who serve as full-time faculty members.17

Nurses for a Healthier Tomorrow, a coalition of nursing and healthcare organizations, is seeking ways to inspire a new generation of nurse educators.18 Its campaign features stories of nurse educators that highlight the rewards of teaching and a nurse educator career profile, accessible on the Nurses for a Healthier Tomorrow website.

Without nursing faculty, there won’t be enough nurses to meet the country’s needs. Nursing needs to attract an increasing number of men and women who want to work with students as their primary “clients” and who want to pursue teaching as their primary role. Future nursing faculty, standing on the shoulders of past and present nurse educators, must be excited about designing and presenting effective curricula to students and dedicated to developing evidence-based teaching strategies for nursing’s future generations.

Now Is the Time

If you like helping others develop to their full potential and would like a change, there’s no better time than now to start a path toward being an educator. Simply put: We need you. Students need you to guide them toward reaching their goal of gaining the skills needed to give excellent patient-centered care. They need your help to learn how to collaborate with various healthcare professionals and take their place as leaders (both at the bedside and within healthcare organizations). Educators need you to help alleviate the stress of their workload and allow them to be the teachers they know they can be. Patients need you to guide students and keep them safe; ultimately, they need you to ensure that when they call for a nurse, there’s one there to answer.
If you’re like most nurses who are thinking about going into education, you probably have excellent clinical skills and work experience that will be invaluable to you, your peers and students. Most likely, you can recall bright teachers who had “been there, done that” with diverse patients and situations. You remember how much it helped to have teachers who could mentor and teach from experience.

You don’t have to do it all at once. Consider your work and personal responsibilities and be realistic about your time. If you’re nervous, start by taking one course that you know is required and transferable, so you can see how it goes. Increasingly, today’s programs are willing to transfer credits. For example, having a course in statistics is often required and transferable. Not only will you get “the feel” of being back in school, you can get this course (one that can be quite rigorous) out of the way, while only taking one subject.

There’s no doubt that nursing education is challenging, but there are countless rewards. As the saying goes, “I didn’t say it would be easy. I said it would be worth it.” Be a nurse and you touch many lives. Teach a nurse, and the number of lives you touch grows exponentially. Why not join the ranks of nurses who can say, “I teach. What’s your superpower?”19 

EDITOR’S NOTE: Maureen Habel, MA, RN, the original author of this educational activity, has not had an opportunity to influence the content of this version.

OnCourse Learning guarantees that this educational activity is free from bias.

Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, is an award-winning author of several nursing books and president of Teaching Smart/Learning Easy in Stuart, Fla.

References

1. Academic progression in nursing education: a living document from the National League for Nursing. National League for Nursing (NLN) Web site. http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/nlnvision_1.pdf?sfvrsn=4. Published January 2011. Accessed April 2, 2016.

2. American Association of Colleges of Nursing Task Force on Future Faculty. Faculty shortages in baccalaureate and graduate nursing programs: scope of the problem and strategies for expanding the supply. American Association of Colleges of Nursing Web site. http://www.aacn.nche.edu/publications/white-papers/faculty-shortages. Published June 2005. Accessed April 2, 2016.

3. Nursing faculty shortage. American Association of Colleges of Nursing Web site. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage. Updated March 16, 2015. Accessed April 2, 2016.

4. Committee on Quality of Health Care in America. To err is human: building a safer health system. Institute of Medicine Web site. http://iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx. Published November 1999. Accessed April 2, 2016.

5. Shever LL, Titler MG, Kerr P, Qin R, Kim T, Picone DM. The effect of high nursing surveillance on hospital cost. J Nurs Scholarsh. 2008;40(2):161-169. doi: 10.1111/j.1547-5069.2008.00221.x.

6. Hilton L. Degrees matter. Nurse.com Web site. https://news.nurse.com/2014/04/15/degrees-matter/. Published April 15, 2014. Accessed April 2, 2016.

7. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824-1830. doi:10.1016/S0140-6736(13)62631-8

8. The future of nursing focus on education. National Academies of Sciences, Engineering, and Medicine Web site. https://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Education.aspx. Published January 26, 2011. Accessed April 2, 2016. 

9. Spencer J. Increasing RN-BSN enrollments: facilitating articulation through curriculum reform. J Contin Educ Nurs. 2008;39(7):307-313.

10. NLN-Carnegie study examines nurse faculty workload. National League for Nursing Web site. http://www.nln.org/newsroom/news-releases/news-release/2007/09/20/nln-carnegie-study-examines-nurse-faculty-workload-208. Published September 20, 2007. Accessed April 2, 2016. 

11. Career as a nurse educator. National League for Nursing Web site. http://www.nln.org/about/career-center/career-as-a-nurse-educator. Accessed April 2, 2016.

12. Certification for nurse educators (CNE). National League for Nursing Web site http://www.nln.org/professional-development-programs/Certification-for-Nurse-Educators. Accessed April 2, 2016.

13. Kalb KA. Core competencies of nurse educators: inspiring excellence in nurse educator practice. Nurs Educ Perspect. 2008;29(4):217-219. 

14. Competencies. Quality and Safety in Nursing (QSEN) Institute Web site. http://qsen.org/competencies. Accessed April 2, 2016.

15. Academic progression in nursing education: a living document from the National League for Nursing. National League for Nursing Web site. http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/nlnvision_1.pdf?sfvrsn=4. Published January 2011. Accessed February 23, 2016.

16. Spigel S. Nurse Reinvestment Act. State of Connecticut General Assembly Web site. http://www.cga.ct.gov/2002/rpt/2002-R-0712.htm. Published August 20, 2002. Accessed April 2, 2016. 

17. Nurse faculty loan program. Health Resources and Services Administration Web site. http://www.hrsa.gov/loanscholarships/repayment/faculty/. Accessed April 2, 2016.

18. Nurse educator recruitment campaign. Nurses for a Healthier Tomorrow Web site. http://www.nursesource.org/campaign_news.html Accessed April 2, 2016.

19. 10 teacher quotes to inspire your passion. SimpleK12 Web site. http://www.simplek12.com/k12/10-teacher-quotes-to-inspire/ Accessed
April 2, 2016.

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