Joumal of Advanced Nursmg. 1995,21, 743-747

Nursing faculty practice: challenges for thefutureLinda Moore Martm RN MNNursmg Instructor. Red Deer College, Box 5005, Red Deer, Alberta, Canada T4N 5H5

Accepted for publication 14 June 1994

MARTIN L M (1995) foumal of Advanced Nursing 21, 743-747Numng faculty practice- challenges for the futureJust as artists need to create their own art, so nursing instructors need topractise nursing However, traditional educational settings and chnicalplacements limit the capacity of nursmg instructors to practise nursmg directlywith clients The creation of a nursmg faculty practice model in Canada,whereby teachmg roles and responsibilities are combined with chmcal practice,IS discussed within the context of a community college environment A nurse-managed health centre is suggested as an innovative practice arena which ismore in line with the changes in the health care system

INSTRUCTORS NEED TO PRACTISE

Just as artists need to create their own art, or musiciansneed to practise their craft, so nursmg mstructors need topractise nursmg For many nursing mstructors in a com-munity college setting, clinical practice has been throughstudents helpmg them to acquire the necessary knowl-edge, skills and attitudes needed for the nursing of othersPractismg directly with chents could afford nursmginstructors a greater opportunity to expand and ennchtheir own chnical knowledge and skills The question is,how can teaching roles and responsibihties be combinedwith those of a clinical practitioner, m one position''

The need to create a place for recognized practice stemsfrom the high regard and value many place on clmicalpractice m nursmg A number of authors share the beliefthat cluncal practice is nursing's 'raison d'etre' (Benner1984, Stamton et al 1989) Others believe that since nurs-mg instructors are responsible for supervizmg students mclimcal areas, access to direct practice is an activityneeded for clmical teachmg (Smith 1980, Joel 1985)However, traditional educational settmgs and clinicalplacements limit the capacity of nursmg instructors topractise nursing directly with chents At the same time,the turbulence and complexity withm the current healthc£ire system are providmg the opportumty to effect a visioncrucial to achieving new directions

Responsibility

It could be said that nursing mstructors have som.eresponsibility m shapmg the future delivery of safe andhumane nursmg care Faculty practice creates opportu-nities whereby nursing faculty have an impact on boththe health care and educational systems (Polifrom &Schmsdenberg 1985) Providmg creative leaming experi-ences for faculty and students enables nursmg instructorsto target both systems equally

Polifrom & Schmalenberg (1985) descnbed a 'chmcalconsultancy program' whereby both nursing service andnursmg education were served This programme providedopportunities for direct patient care, role modellmg, headnurse support, mservice education, project developmentand information resources Faculty involved as chmcalconsultants described more effective teachmg and practiceas a result of the programme

WHAT IS NURSING FACULTY PRACTICE?

The context for nursmg faculty pracbce in this paper isbuilt on the premise that nursmg is a practice disciplmeHistoncally it could be said that the roots for faculty prac-tice stem from the Frontier Nursing Service of the 1920s(Sulis & Deloughery 1991), where family health care wasprovided by nurses Faculty practice has a wide range ofdefimtions and charactenstics, ranging from jomt appomt-ments and 'moonlightmg' to health centres nm by nursmg

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faculbes Regardless of the type of pracbce, there tends tobe a common intent to maintain, improve and masterclinical knowledge and skills m order to mcrease the qual-ity of care to clients

Faculty practice, as suggested here, is not somethingdone in a secondary position but done withm the contextof a faculty position which ensures that it receives therecogmbon it nghtfully deserves Valumg clinical pracbceIS an acbvity believed necessary for chmcal teaching Thedefinition that fits best with these beliefs is

The provision or facilitation of the dehvery of nursing carethrough advanced behaviours of research, mentonng, leadership,collaboraUon, and direct patient care with outcomes of scholar-ship and student learning

(Campbell 1993)

of mdividuals and famihes The pnmary purposes of sucha centre would be to fecihtate student learmng, provideopportumbes for faculty to practise directly with clients,and to provide advanced pracbce nursing services to thecommumty Nursmg services would be provided withinthe parameters of counsellmg, referral, educabon, mfor-mabon and health assessments

A number of nurse-managed centres are m oper-abon today In May 1994 the Comox Valley NursmgCentre Demonstrabon Project opened, sponsored by theRegistered Nurses Association of Bnbsh Columbia(RNABC) and financed by a grant from the BnbshColumbia Provincial Ministry of Health The centre meetsthe new health care policy framework for BnbshColumbia, while meebng the identified needs of thecommunity

Purposes

Clearly, the purposes of faculty pracbce include to pro-vide opportunity for faculty to pracbse nursing directlywith chents, thereby enhancing teaching and cliniced abili-ties, to provide a clinical placement for nursing students,to provide quality nursing services to the community, and,to provide opportunities for clinical research The overalloutcome is to increase the quality of patient care

There is a need to create some means by which pracbceIS not only rewarded but even, to some degree, expectedIt requires combinmg teachmg roles and responsibilibeswith those of direct cluucal pracbce This combinabon isviewed as one position and, as such, clinical practice isrecognized and treated as worJdoad

NURSING FACULTY PRACTICE MODEL

The vision for a nursing faculty pracbce model arose froman assessment of women's health informabon needs con-ducted m 1993 (Martm 1993) The results of the assess-ment revealed the need for accessible programmes andservices at an affordable cost, available free to those whocannot pay and provided by women who have experbsein women's health issues Programmes and services mustbe beised on current, accurate, genume and specific infor-mabon and be offered within a comfortable environmentThe women responding to the survey asked for educabon,referral, mformabon and support services An overwhelm-ing 89% believed there was a need for a service specificto the health needs of women While the focus of thisneeds assessment was women, it is the author's contenbonthat the ldenbfied needs could be generalized to othergroups

La the light of these results, the proposed model for fac-ulty practice is a nurse-managed health centre Nursingservices would be dehvered by nursmg faculty v«thexpertise m providing nursmg care to specific populabons

Midwifery

Nichols (1985) descnbed the Yale Nurse—MidwiferyPracbce m the USA m which faculty members providedprenatal, lntranatal and postnatal nursmg care m a clmicsetbng High-quality nursmg care was an outcome measuredemonsfrated repeatedly from women accessing thisparticular service

Barger & Kline (1993) described a three-fold faculty prac-bce model m which a nursmg centre, a wellness pro-gramme and a home health programme were designed toprovide cluucal expenences for students Students andnursmg faculty worked together m providing nursing ser-vices to people withm the community As well, m a studyby Pulliam (1991) the central themes of high-quality physi-cal and psychosocial care and a perception of enhancedcontrol over health care needs were ldenbfied by clientsaccessing a nurse-managed commumty health centre Theconsensus seems to be that people cared for by nurses mthese centres reahze greater sabsfaction with the care theyreceive It has heen documented that nursing services arecost-effecbve m the provision of health care to low-buthweight infants, asthmabc children, low-mcome famil-ies and chromcally ill hospitalized pabents (Brooten et al1986, Alexander 1988, Bair et al 1989, Begley et al 1989,Gravely 1992, Wilkms 1993)

Consistent cost-effective care

It has been asserted that health centres m general are morecost-effecbve, fill recogmzed gaps and provide a uniqueservice to meet the needs not effectively addressed else-where (Alberts et al 1987, Rynne 1989, Swaffield 1989)Further, they provide an avenue for more consistent carewhich mcreases the confidence of those seekmg assistance(Wmgert etai 1980)

To this end, services for the model proposed herecould mclude workshops and senunars, workplace and

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commimify-based programmes, a telephone service,mdividual and group sessions, referral services to other^encies and health care professionals, puhhc forums onhealth-related issues, and health assessments Specificworkshops and seminars may address such issues as breasthealth, sexual health, families and AIDS, bme manage-ment, career-fenuly balance, reproducbve health, chronic-lfy, and prenatal/postnatal needs The telephone servicecould he staffed by a combinabon of faculfy and nursingstudents Providmg evenmg and weekend hours of servicewould address the issues of availabilify and accessibilifyIn addibon, lunchtime sessions m the workplace wouldneed to he developed to provide services to those unahleto leave their place of emplo3Tnent

ISSUES AND CHALLENGES

While there is support for this model of faculfy practice,one IS remmded that it is not without its drawbacksMcClure (1987), m a discussion of the Faculty PracbceProgram at the New York Umversify Medical Center, sug-gested that role stram, conflict and overload were sourcesof concem due to the bme and energy commitmentrequired for a successful model With decreased fundmgto education, nursing mstructors are expected to do morewith less It IS cnbcal then to elicit firm commitment fromthe school of nursing in order to minimize the effects ofrole strain and for the chosen model to survive (Nichols1985, Nettles-Carlson & Fnedman 1985)

Recently, the Red Deer College Nursing Faculfy voicedtheir commibnent to the implementation of a nurse-managed health centre Further explorabon of workload isneeded, however, to ensure that faculfy do not 'succumb'to the effects of role strain

Smith (1980) advocated that faculfy practice should heviewed as a legitimate focus withm the lnsbtubon's man-date This means that the commumfy college publiclyendorses faculty pracbce, facilitates workload fiexihilify,provides equipment, supplies and space, and formallyrecognizes models of faculty practice withm the msb-tubon It IS agreed that if this concept is to he successfulIt needs to he puhlicly endorsed by the college adminis-frabon and board

Addressing conflicts

There is also a need to address the conflicts which mayanse between the needs of the commumfy and the avail-abilify of nursing faculfy to meet those needs (McClure1987) For example, what happens to services and pro-grammes when faculfy are on summer holidays' This issuecould he addressed through term contracts and hirmgsemor nursing students over the summer to man telephonehnes In order to mamtam a high profile, it would makesense to offer some services all year round

The whole area of finance generates its own hst of con-cems m terms of compensabon, start-up costs, and yfhopays the bills The health centre would need to be eithera cost-recovery or profit-making entify to gam endorsementwithm the college environment, given the current econ-omic realibes But m bme it could be a source of revenuefor college operabons and speaaJ projects Profits mightalso be used to hire students needed for staffing in thesummer

While the concept of faculfy practice raises many issues.It poses many new challenges about how nursing instruc-tors think about chmcal practice Quesbons are raised asto what consbtutes workload, ownership of the services,evaluabon of the service and liability issues Another keyissue IS that of who parbcipates in the centre If it is devel-oped under the auspices of the nursing department, doesthat mean that all faculfy play a role m the provision ofservices' And how then are these roles determined' Thesequestions need to be addressed early in the plannmgprocess, as they affect the way the centre will look andoperate

Health promotion

One cannot overlook the potentially explosive response bysome members of the medical profession towards this non-tradibonal, unconventional, innovative method of provid-ing nursing services to health care consumers The empha-sis on curative medicine and the treatment of illness musthe halanced vnth a greater emphasis on the prevenbon ofdisease and injury, and the promotion of health andwellness

In 1991, Partners m Health, the Alberta government'sresponse to the Premier's Commission on Future HealthCare for Alhertans, was puhlished This report contameda vision which refiected a move to more home and com-mumfy care, mnovabon and creativify m providing healthservices, a more hohstic view of health, an emphasis onhealth promobon and disease prevention, facilitabon ofconsumer choice and responsihilify, and an emphasis onhealth care provider coUaborabon and coordinabon(Government of Alberta 1991) While it is acknowledgedthat the current pohbcal climate between nursing andmedicme may not he encouragmg towards collaborativepracbce, the expertise and competence of both are neededto meet the shifting demands of consumers Working col-laborabvely would serve to educate medicme and thepuhlic on the changmg role of the nurse m the provisionof health care

Regardless of the issues faculfy pracbce raises, it wouldprovide a direct means and a unique environment inwhich to mtegrate nursmg pracbce acbvibes with teachmgand research mterests In this way, it is believed thatteachmg performance and )oh sabsfacbon would be en-hanced (Nettles-Carlson & Fnedman 1985, Nichols 1985)

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Opportumbes for nursmg research would be increased asa centre would provide numerous arenas for scholarlyresearch (McClure 1987, Just et al 1989) Studymg out-comes would provide information on the quality andeffecbveness of the nursing services If it could be demon-strated how these nursing services produced healthieroutcomes for mdividuals and their &mihes, addibonalfunding may be atbacted from outside sources

Student leaming avenues

In addibon to research acbvibes, there is a need to createnew avenues for student leaming which keep pace withthe changing environment of nursing and the health caresystem The creabon of a nurse-managed centre would pro-vide students with the opportunity to work in an mnov-abve pracbce area which is more m lme with the futuredirections of the health care system Gammg firsthandexpenence m a nurse-managed centre would better pre-pare nursmg students for the future (Barger & Klme 1993)

One role of the nursing instructor is to facilitate learmngand to promote excellence in nursmg pracbce based onever-expanding knowledge and research According toDavies (1993), opportunibes for students to role modelfaculty m pracbce provides 'a means of discovermgknowledge embedded m clinical pracbce', and providesa powerful venue for leaming The provision of opportu-nities for role modelling faculty also serves to narrow the'service-educabon gap' that has existed m nursing Byhavmg faculty directly involved m clmical pracbce, theability to maintain a more realisbc perspective for theenvironment students will eventually work in is realized(Bidwell & Brasler 1989, Tully & Bennett 1992)

Role modelling assists m creating a new context for pro-fessional nursing practice Students' imderstandmg of col-legiality, mutual responsibility, professional atbtudes,behaviours and competence are parbcularly enhanced anddeveloped through the process of faculty pracbce (Bidwell& Brasler 1989, Tulley & Bennett 1992, Davies 1993,Arthur & Usher 1994) Shay & Stalhngs (1993) developedInsbtutes for Nursmg Excellence designed to determmethe effects of role modelling on the rejuvenabon andrenewal of staff nurses The staff nurses reported the great-est changes to be in terms of personal and professionalgrowth Creatmg opportumbes for role modellmg earlierm a nurse's educabon could foster personal smd pro-fessional growth at a tune cnbcal to students' developmentand leaming

Community partnership

The nursmg faculty at Red Deer College values excellencein teachmg and supports developmental acbvibesdesigned to ensure that faculty are credible and currentIn the same vem, innovabve services and programmes that

are sensibve to commumty need are valued There is mter-est at Red Deer College m promoting a level of excellencewhile becoming more visible withm the communityWorkmg m partnership with the community provides aviable avenue for increasmg the quahty of health caredelivery and creates a more favourable climate for growthand change (Lenz & Edwards 1992) The model for facultypracbce suggested here is based on commumty need andIS an mnovabve way m which to meet those needs

The expertise exists withm the Red Deer College NursmgFaculty to create an altemabve model for health care anda model teaching centre for student learmng In otherwords, 'model teaching centres for students, where the bestof nursmg pracbce could he observed, leamed, and tested'(Lang 1983) The challenge lies in having this experbsevalued and recognized through the creation of a nursingfaculty practice model

Acknowledgement

The author would like to thank Dr Nancy Grant for herediting experbse and support m the completion of thispaper

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