In a recent study, students identified a lack of clinical expertise by faculty who do not work at the bedside as a factor that contributes to challenging clinical learning environments (O’Mara, McDonal, Gillespie, Brown, & Miles, 2014). Nurses who work at the bedside are well positioned to teach undergraduate nursing students about current practices that meet the highest standards of quality and safety. However, staff nurses who are interested in teaching often lack the education or professional development needed for assuming the role (Dahlke, Baumbusch, Affleck, & Kwon, 2012). Academic-practice models that employ hospital staff nurses as clinical faculty could be an effective strategy for both reducing the theory-practice gap commonly seen among new graduate nurses and supporting the development of nurses in practice to assume an educator role. Results of a systematic review indicated that academic-practice partnerships were the most common method for addressing the clinical nurse faculty shortage (Wyte-Lake et al., 2013). However, understanding the effectiveness of these partnership models from the perspective of students and faculty who teach in these roles remains an underexplored area of research.
A mid-western school of nursing and its affiliated academic medical center developed an academic-practice model to address the clinical faculty shortage and improve student and faculty learning experiences. The onboarding model was adapted from Letcher and Nelson’s Culture of Caring Partnership Bundle (2014) and Reid’s Eastern Shore Faculty Academy and Mentorship Initiative (ES-FAMI) (2013). Staff nurses are contracted to teach clinical one day per week while maintaining their full-time status in the hospital. Nurses who either hold or are actively pursuing a graduate degree in nursing and are employed full-time at the hospital are eligible to apply for an affiliate faculty position. Affiliate faculty exchange one 12-hour shift in the hospital for teaching one group of six BSN students one day per week in the hospital. Since the start of this partnership, the school of nursing has been able to reduce student to faculty ratios from 8:1 [HN1] to 6:1, while reducing costs and time spent onboarding faculty. Recently, there have been more RNs applying for clinical affiliate positions than openings available, showing the growing popularity and sustainability of this model.
Purpose and Aims: The purpose of the study was to evaluate both student and affiliate faculty perceptions of the effectiveness of the academic-practice partnership affiliate faculty model. The specific aims were to:
- Understand the student perception of affiliate faculty as clinical experts and their ability to reduce the theory-practice gap.
- Discover whether student perception of safety is improved in clinical settings when under supervision of an affiliate faculty.
- Explore the affiliate faculty model as a way of addressing the clinical faculty shortage.
- Describe the potential benefits and challenges of the affiliate faculty model.
Methods: This study used a mixed-methods descriptive survey design. Nursing students who completed the BSN program at the school of nursing between the years of 2012-2017 and affiliate faculty who taught at least one BSN clinical in the affiliated hospital during that same time were invited to participate in the study. A letter of invitation and link to an electronic survey was emailed to all potential participants. The survey consisted of Likert-type questions (ranging from 1 = strongly agree to 5 = strongly agree) and open-ended questions. Survey Monkey was used to administer the survey and collect responses. Data were collected from March through April 2017. The study was approved by the academic medical center internal review board prior to implementation.
Results: In total, 72 student graduates participated in the study. Students reported having more clinical experiences with affiliate faculty (3-5 semesters = 62.5% of respondents) than with non-affiliate faculty (2 semesters or less = 69.7%). An overwhelming majority (65/66 respondents) agreed or strongly agreed that their affiliate faculty were clinical experts, and prepared them to deliver safe nursing care. The majority of student respondents (54/65, 83.1%) also agreed or strongly agreed that their affiliate faculty impacted their ability to connect classroom concepts to clinical practice. Students had mixed perspectives when asked to describe any differences they found between affiliate and non-affiliate faculty, with 12 reporting no difference, 10 reporting affiliates being less favorable than non-affiliates, and seven reporting affiliates as more favorable. When asked to describe benefits they experienced in being taught by affiliate faculty, students (n=20/31) reported affiliate faculty’s knowledge of the curriculum and health system, commitment to teaching, instilling confidence, support at the bedside, and being a resource for employment.
Twenty-five affiliate faculty participated in the study. There was a wide range in nursing experience, ranging from 0-3 years (28%) to 11 years or more (24%). The majority (60.9%) of faculty respondents had taught as an affiliate faculty for 2-3 semesters. All faculty respondents agreed or strongly agreed that their affiliate faculty role benefited the students, and benefited the unit they taught on. The majority (85.7%) of faculty respondents agreed or strongly agreed that they were able to help students connect classroom concepts to clinical practice. All respondents (n = 23) agreed or strongly agreed that they were able to prepare students to provide safe patient care. When asked to describe any potential conflicts in their role, affiliate faculty responded: none (n=11), time/scheduling (n=5), and staff nurse conflicts (n=2). When asked to describe what they enjoyed the most about the role, affiliate faculty responded: being with students (n=7), connecting classroom to clinical (n=7), teaching hands on/skills (n=5), and seeing students develop or “light bulb moments” (n=6). When asked to describe what was most challenging about their role, affiliate faculty responded: time/grading/scheduling (n=11), barriers to teaching (n=4), and student issues (n=3).
Conclusions: Many benefits of the affiliate faculty model were identified, including student perceptions of their clinical faculty as experts and ability to prepare them for safe nursing care delivery, and ability to connect classroom concepts to clinical practice, both from the perspective of the students and affiliate faculty. Students either reported no difference or more benefits of having an affiliate faculty compared to non-affiliate faculty. When implementing an affiliate faculty model, it is important to consider time management and scheduling needs of the affiliate faculty. Overall, affiliate faculty reported enjoyment of their experience, especially with the “light bulb moments” that come with teaching.
[HN1]I am not certain if this is the correct number. Do you know? I think it will be important to show the amount of decrease.