Faculty development initiative goal to increase clinical faculty.

In 2005 the Colorado Center for Nursing Excellence was awarded a $1 million dollar grant from the Colorado Department of Labor and Employment to address the severe and worsening shortage of clinical faculty in the state of Colorado. This represents one of the most significant bottlenecks in the provision of adequate numbers of new nurses in our state and nationally. The original grant identified a target of 45 new clinical faculty members called Clinical Scholars.

What is a Clinical Scholar?

The concept of "Clinical Scholar" is not a new one but has evolved from the model developed at the University of Colorado. The Clinical Scholars are employees of specific clinical facilities and are selected due to their expert clinical skills. The project was constructed so that these employees would not lose salary or benefits but would stay in exactly the same job position in the agency. The plan required that they be released from their usual staff nurse roles to take rotations of approximately six nursing students into a clinical area in their home facility usually two to four times a year. The schools pay the facility for the use of their employees' time and expertise.

These Scholars differ from the model developed at the University of Colorado in that the partnership exists between a number of agencies and multiple schools as opposed to a single school and their clinical partners. Thus, many more students are impacted. Although Masters preparation is the goal, the Clinical Scholars are not all currently prepared at that level. In addition, they have formal, didactic preparation for this role which is a major difference from the historical norm.

The Preparation

The Clinical Scholar didactic course has met with tremendous success and demand! The collaboratively developed curriculum for the forty hour course was created by a committee comprised of both academic nurse educators and facility based staff development nurses. There is a focus on adult learning principles as well as a consensus approach in developing critical content. There is significant emphasis on experiential learning, the use of scenarios, role play, interactive games and discussion. Taught by 26 different metropolitan Denver faculty selected for their dynamic teaching styles and expertise, the course has been offered nine times thus far.

Historically, nurses who have assumed clinical teaching roles have had no formal preparation and support for this role. They have relied on their memory of how they were taught as well as learning on the job by trial and error. As a result of this project the quality of clinical teaching has been enhanced through thoughtful, deliberate preparation as well as increasing the quantity of available clinical faculty.

In contrast to the original plan, to date 344 expert clinical nurses have taken advantage of this unique learning opportunity. Prior to the end of the grant period there will be another three classes offered. The classes have been limited to 35-40 participants. This group includes participants who are new faculty, experienced clinical faculty and unit based educators from clinical agencies.

In order to assess the effectiveness of this project, survey data has been collected regarding the clinical rotations from the Clinical Scholars, the nursing students, the facilities where the rotations were taught, and the schools who utilized the Clinical Scholars. In addition, all of the Clinical Scholars were invited to complete a survey which asked about their experience over the three year project. There was a 66% response rate from the Scholars. The qualitative responses to the open ended questions are still being analyzed. Below is a summary of responses to these surveys.

Benefit to students

Students receive clinical education from a competent Clinical Scholar who is able to role model excellent nursing practice. In addition, the nurse knows where to park and how to use the information system! Students experiencing a rotation with a Clinical Scholar were surveyed. Ninety seven percent of the students believe that the Scholars demonstrate expert clinical knowledge. Ninety five percent of the students identify positive attributes in the Scholars. Ninety two percent of the students believed the clinical experience provided was of high quality. Ninety three percent of the students believed that they were fairly evaluated by the Clinical Scholar during their rotation.

The nursing students served by this model were positive about the agencies that provided clinical sites for their rotations. They reported that the staff and unit environment were supportive of learning and had adequate census and acuity to provide a strong experience.

Benefit to schools

The original impetus for this project was to address the severe and worsening clinical faculty shortage. It was not uncommon for clinical student rotations to be cancelled due to lack of clinical faculty. Due to the shortage, it was also possible for a faculty person in one specialty to be assigned to supervise nursing students in another area where they had no current expertise, knowledge or interest.

Regarding clinical experiences, the schools responded that the Clinical Scholars provided a high quality clinical rotation to their students 97% of the time. One hundred percent of the responding schools believed that the scholars were clinically knowledgeable--a stark contrast to some previous reports regarding clinical educators! More than 80% of the time the schools believed that scholars integrated classroom content into clinical experience and successfully incorporated school policy and philosophy into the clinical setting.

Benefit to agencies

Initially, the burden of actualizing this model seemed to fall most heavily on the agencies that employ these nurses. The agency would need to release some of their most valuable clinicians to be able to lead student rotations. Also, although the grant had financial incentives to ease the burden there is a financial cost to agencies with this model outside of grant funding. In this project the schools paid their usual adjunct faculty stipend directly to the hospital to cover the Scholars' services during the rotation. This amount generally is significantly less than these nurses typically earn, particularly when differentials and the benefit package is included.

However, regardless of the cost, the facilities have significantly benefitted from this project and are so pleased with the outcomes that they will continue to support this model even without financial support from external funders. For example, agencies believed that the Clinical Scholars enabled a higher quality of nursing care to be delivered to patients by student nurses at least 93% of the time. Overwhelmingly, the facilities support the utilization of Clinical Scholars (97%). Historically, nursing units who have suffered staffing shortages have been resistant to accepting student rotations. In contrast, when the rotation is taught by employees of the facility who are frequently known to the staff, this resistance is significantly decreased. Moreover, in excess of 77% of the Clinical Scholars report enhanced commitment to their home agency, a real benefit from a retention perspective.

More than 65% of the scholars have referred their best students to Human Resource departments in their agency for possible professional employment. The majority of the students indicated that they would consider that facility for future employment. It is easy to see that when a student has a positive experience in an agency they are predisposed to consider that agency for a job. Thus it is possible to recruit high quality candidates for their open nursing positions who have been pre-screened for fit and positive work attributes. Probably the most critical finding for the agencies is that respondents to the survey believed that with Clinical Scholars as faculty, patient safety was enhanced 91% of the time as compared to the more traditional model.

Benefit to the Scholars

This model has been enthusiastically embraced across the community for a variety of reasons. One of the most important is because the Clinical Scholars report that there is a significant increase in their job satisfaction with the addition of teaching responsibilities. Enthusiasm for the nursing profession has markedly increased by attendees (93%). Interest in continuing their academic education which may not have been high at the outset was markedly increased as a result of attending the course. Additionally, the Clinical Scholar group reported a myriad of personal benefits derived from the course such as increased skills in conflict resolution, feeling more positive regarding their position as a "citizen of the profession" in nursing and being more conversant regarding the larger picture of nursing.

How do I learn more?

The Clinical Scholar didactic courses will continue under the auspices of the Colorado Center for Nursing Excellence. To obtain more information contact Marianne Horner, Project Liaison, 303-715-0343 or Marianne@ coloradonursingcenter.org.

We would like to acknowledge Janet Houser, PhD, RN at Regis University for her invaluable assistance with the evaluation and analysis of the extensive data from this project.

Karren Kowalski, PhD, RN, NEA-BC, FAAN Project Director

Marianne Horner, RN, MSN, CNMP Project Liaison