Tenure practices in allied health and nursing.

Abstract

This manuscript presents an in depth review of the literature on the tenure policies and practices in allied health and nursing education. Specifically, the manuscript summarized the existing published studies that investigated the educational requirements for tenure; promotion and tenure rate; the role of scholarship in tenure decisions; teaching and service roles in tenure decision; role of clinical practice in tenure decisions; and tenure innovations.

Introduction

Tenure is probably the most cherished reward that is well sought after within the professorate. Tenure is an affirmation of the potential and future promise of a faculty member to excel in academia based on the evidence of past and current contributions to the institution and to the profession. The ongoing changes in contemporary society, economics and technology are forcing colleges and universities to alter their time-honored traditions about tenure (Tower, 1996).

Allied health and nursing disciplines share similar history as "helping professions" that moved their education from the hospital setting into the university milieu. Both disciplines, at the beginning, awarded certificate, associate degree and later baccalaureate degree to their graduates. Over the years, the number of institutions offering doctoral degrees in nursing has grown from zero prior to 1951 to 87 in 2005 (American Association of College of Nursing (AACN), 2005). There are growing numbers of post-doctoral research opportunities, which are designed to produce the next generation of nursing scholars and advance the quality of nursing care. Some allied health disciplines such as physical therapy, occupational therapy, speech therapy, and audiology are transitioning to an entry-level doctoral degree conferring profession. However, the overwhelming majority of the allied health disciplines have no doctoral program.

Despite the similarities between allied health and nursing, there are obvious differences between the two professions. Nursing is a more homogeneous group; on the other hand, allied health is more diverse with over 200 specialty disciplines with varying levels of education leading to the award of a certificate, an associate degree, a baccalaureate degree, a master's degree, a doctoral degree or post baccalaureate training in a science relating to health care (US Department of Health and Human Services, Bureau of Health Professions, Human Resources Service Administration (DHHS, BHPr, HRSA), 2005). In academia, both nursing and allied health disciplines continue to face similar challenges with respect to the policies and practices surrounding tenure.

Scope of the Review

Following an exhaustive search of the literature on two major data bases (i.e., MEDLINE and CINAHL) using the terms "tenure", "allied health" and "nursing", we found 35 published studies that shed light on the tenure system. The preponderance of the investigation on tenure were in the early 1980's and 1990's. This manuscript presents an in depth review of the extant literature on the tenure policies and practices in allied health and nursing education. Specifically, we reviewed all the existing published studies that focused on the educational requirements for tenure; promotion and tenure rate; the role of scholarship in tenure decisions; teaching and service roles in tenure decisions; role of clinical practice in tenure decisions; and tenure innovations.

Educational Requirement for Tenure

Institutions with tenure systems are increasingly faced with the need to reconsider the criteria used to award tenure. The traditional criteria used for granting tenure in academia are categorized into three broad domains: scholarship, teaching and service. A critical requisite for recognition as a "scholar," in any discipline, is an appropriate education at the doctoral level. Doctoral education fosters the acquisition of depth and breadth of knowledge in a field of study, and provides opportunities for socialization into the community of scholars. Although each discipline in academia has developed its own criteria for tenure, one basic tenet is that faculty members are expected to have a doctorate prior to tenure. In health profession, nursing and allied health disciplines have been an exception to establish this basic tenet as a requirement for tenure consideration. Educators in both fields have often demanded different criteria for tenure than those used in traditional disciplines because the majority of the faculty members in their ranks enter the academy with Master's degrees instead of doctorates.

Two decades ago, a Master's degree was the terminal degree required for faculty positions in nursing and many allied health disciplines, but this is no longer the case. For example, 46% of laboratory science faculty, nationally, have made progress in earning doctorates and 49% achieved higher academic ranks (Waller et. al. 1990). Today, a doctorate is currently the educational requirement for tenure in most universities. According to Perry (1982), faculty not willing to pursue doctoral study and engage in scholarship "should be given terminal contracts unless they are making unique contributions to the school; "... the products of an educational program can be only as good as the faculty who teach them.

Many educators now advocate that nursing and allied health disciplines employ faculty with doctorate credentials specific to their discipline (guess, 1995; Sullivan, 1996). While over 60% of the nursing programs required doctoral degrees, either in nursing or a related field for tenure; less than 5% of the nursing programs require a doctorate specifically in nursing (Messmer, 1988). In order to produce better-prepared nurses and allied health professionals with advanced clinical skills, educators with doctorates in their discipline are needed. This line of thought is based on the premise that an effective educator is an individual whose teaching is guided by research and who is capable of articulating the topical developments in their discipline. More than ever before a "critical mass" of nursing and allied health scholars is required to advance the knowledge base of their profession, generate new knowledge and disseminate it through publication in peer-refereed journals. Holcomb and Roush (1998) surveyed allied health educators in academic health centers in the southern States. Over 56% of the faculty, indicated that their own academic preparation was the primary factor that encouraged their scholarly pursuits; 62% of the faculty stated that heavy teaching responsibility was the primary discouraging factor for scholarly work. In a recent study, Balogun and Sloan (2005) found that 72% of allied health deans and 68% of nursing deans indicated that a doctorate is the degree required for tenure in their institutions.

Promotion and Tenure Rate

Promotion and tenure are usually discussed together in the literature, but they constitute two independent events that may or may not occur simultaneously depending on the institution. Tenure is the expectation of continued employment conferred on a faculty member working for a certain number of years on probationary status and is generally linked to academic freedom and property rights of the faculty member. Promotion serves as a reward for past accomplishments that convey distinctions among academic ranks. Tenure represents the vital and long-term contributions of the faculty members to the institution, and it is conferred upon attaining the rank of associate professor or higher status (Hodges et. al, 1992). Moore (1989) surveyed faculty in five disciplines (physics, psychology, sociology, nursing, and management) in selected American universities to gauge their perception on tenure decision. The faculty believed that many factors influenced tenure decisions, but achievement criteria were identified by members of all disciplines as the most important determinants used during tenure review. O'pt (1989) assessed the tenure policies and tenure rate in academia and found that only 36% of allied health faculty are tenured, compared to 58% for other disciplines. In another study, Waller and associates (1990) found that 50% of laboratory science faculty, nationally are tenured. In a diametrical finding to the earlier studies, Gropper (1998) found that the tenure rate for nursing faculty range from 80% to 92% (Mean = 89%) depending on the type and mission of the institution. Research oriented private universities had the highest tenure rate of 95%.

In a more recent study, Pohl and associates (2002) found that only 37% of the nursing faculty were tenured. The predictors of tenure included consideration of clinical competence and institutional support for clinical practice. Similarly, Balogun and associates (2005) found that allied health and nursing faculty had 47% and 35% tenure rates, respectively. The tenure rate for allied health faculty was significantly higher than the nursing faculty. The low tenure rate, reported in the last 5 years, for allied health and nursing educators is often attributed to the faculty members underperformance in the scholarship domain. A conundrum facing allied health and nursing disciplines is the need to find creative and measurable standards to gauge scholarship and ways to effectively incorporate the measures into the tenure guidelines. In 1998, Boyer proposed a broader and more inclusive paradigm for scholarship that includes discovery, integration, application and teaching. The model has gained wide acceptance and is currently used in fashioning the criteria for tenure in nursing and allied health education (Agstadt et al, 1998; Adderly-Kelly 2003).

Role of Scholarship in Tenure Decisions

Scholarship represents publication of research findings in peer refereed journals, presentation of research in scientific fora, authorship of books/chapters, and submission of grant proposals. In both nursing and allied disciplines, scholarship is increasingly becoming a highly valued activity considered for tenure, but many educators perceive tenure criteria as becoming more rigorous with greater weighting attached to the scholarship domain (Adderly-Kelly, 2003). Baird and associates (1985) surveyed nursing faculty to gauge the critical factors used in the award of tenure. Over 50% of the faculty considered scholarship as "highly important" in promotion and tenure decisions. When respondents were broken down into categories such as size and type of institution and availability of a graduate nursing program in the institution, there were distinct differences in the activities considered "scholarly". In another study, Conine et. al. (1985) found that only ten of the 48 documents typically submitted in the portfolio of allied health faculty for promotion and tenure reviews were considered to be essential for tenure. The most important activity predictive of career advancement was scholarship, even though the majority of the faculty believed it should be teaching.

Kruger and Washburn (1987) evaluated the status of tenure and promotion practices in nursing education by surveying deans of selected nursing programs nationwide. Their findings revealed that a growing number of nursing programs are well integrated into the academic community, although many programs lacked, faculty prepared at the doctoral level and faculty with scholarship track records. In a follow up study, Melland (1995) found that the majority of nursing faculty reported "high" to "intense" pressure to publish; they belief that the increased emphasis on scholarship diminishes the quality of classroom instruction. The majority of the faculty preferred the option of a teaching-only career track if they could still be promoted and achieve tenure. Gropper (1998) surveyed deans of public and private universities in the southern States to assess the role of scholarship in tenure decision. The deans reported that scholarship was considered the most important in granting tenure in research oriented universities. In another study, Holcomb and Roush (1998) examined the scholarly activities of allied health educators in academic health centers in the southern States. The primary scholarly activities of the faculty were publication in refereed journals and to a much lesser degree, authorship of books and monographs. Over a three year period, 46% of the faculty presented a paper at a scientific forum and 29% had externally funded projects.

Waller et. al. (1999) surveyed allied health deans to ascertain their research productivity and institutional expectations regarding scholarship. They found that the majority of the deans were actively involved in scholarship, spending two thirds of their time in administrative duties. The scholarship productivity (publications and grantsmanships) of deans from research oriented institution was not significantly different from those from non-research institutions. Several previous studies have investigated the determinants of research productivity of nursing and allied health educators, with varying results. Nieswiadomy (1984) found that only 25% of nursing faculty indicated current involvement in research and those with doctorates and those teaching in graduate programs, are the most productive in the scholarship domain. Over 50% of the nursing programs surveyed did not consider scholarship productivity important for tenure and promotion decisions, or salary increase. Ostmoe (1986) found that 32 variables have a significant relationship to research productivity of nursing educators. In all, 16 variables, grouped into three clusters, accounted for 48% of the total variation in the faculty publication productivity. Current job socialization and motivational factors accounted for a significant amount of variation in publication productivity.

Schiller et. al. (1988) found that dietetic educators with doctoral degrees, at the rank of professor, working in research oriented institutions spent significantly more time on scholarship than did other faculty members. Over 67% of the faculty had submitted grant proposals and served as principal investigator for at least one project, and 58% had received research grants. About 50% had published in refereed journals and over 60% had presented their research in scientific fora. More than 50% indicated a need for skills in grant writing, applied statistics, and publication. Flanigan and associates (1988) found that allied health educators who are employed by research oriented universities, earned their doctorates, hold the rank of professor, and are tenured had significantly higher levels of scholarship productivity. Holcomb and associates (1990) found that the primary scholarly activity for physical therapy educators was publication in refereed journals. The majority of the faculty had presented a paper at a professional conference, only few received externally funded grants. A strong administrative support and financial resources is a sine quo non for faculty research productivity, but the level of support for research endeavor among institutions varies. Nieswiadomy (1984) reported that faculty are willing to participate in research, but they are skeptical of the level of support from their institution. In a related study, Schiller et. al. (1988) found that only 15% of nursing faculty agreed that scholarship was financially or administratively supported by their institution and 23% stated that they were confused about the relative importance of scholarship in relation to teaching and service.

Teaching and Service Roles in Tenure Decisions

Teaching is traditionally considered the primary duty of educators in most liberal arts colleges and four year universities. Service is the contribution of educators to the development of the department/college and the institution at large, as well as professional/community organizations and government agencies. Waller et. al. (1990) investigated the primary factors used in tenure decisions. They found that the majority of clinical laboratory science faculty are primarily involved in teaching; only few had an ongoing research agenda; full professors and those with doctorates excelled in the scholarship domain; faculty members in research universities were more productive than those in four-year colleges and universities.

Akroyd et. al. (2001) surveyed deans and allied health faculty employed at public academic health centers nationwide regarding their attitudes toward teaching, scholarship, and the reward systems associated with both. The deans and faculty members did not differ in their views regarding research orientation and rewards related to scholarship. The faculty members and department chairs indicated a higher preference for teaching than did the deans, while tenure-track faculty expressed less belief that rewards influence teaching than did tenured faculty, department chairs, and deans. Messmer (1991) found that 55% of nursing deans ranked teaching as "most important", in contrast to the 45% of deans who ranked research "most important" in tenure decisions. Service was ranked least important by 89% of the deans. Interestingly, 31% of the deans from doctoral programs ranked scholarship more important than teaching, and also ranked service the least important activity. Faculty members who were perceived by their deans as providing high quality teaching, scholarship, and service were, in rank order, more likely to be awarded tenure. In a more recent comparative study, Balogun and Sloan (2005) found that 77% of allied health and nursing deans, ranked teaching as the primary criterion used in tenure decision in their institutions. On the other hand, less than 23% of the deans rated scholarship as the most important criterion used for tenure. Only 1% of allied health deans and 4% of nursing deans consider service as the most important criterion used in tenure decision.

Role of Clinical Practice in Tenure Decisions

In addition to performance in the three traditional evaluation domains, faculty in respected health professions such as medicine, podiatry, dentistry, and osteopathy, are required to engage in clinical practice in their specialty. Herr (1989) determined the receptivity of nursing faculty from public institutions in 15 southern States towards adding clinical practice to the requirement for promotion and tenure. The study revealed that the nursing faculty were more receptive than resistant to the proposal requiring clinical practice as a requirement for promotion and tenure.

Barger et. al. (1992) surveyed the deans of nursing schools nation wide to determine the organizational factors that influence the role expectations of nursing faculty about clinical practice. Over 60% of the deans indicated that their college had practicing faculty, but less than 10% of the deans advocated for clinical practice to be part of the faculty role. Similarly, only 16% of the deans reported that faculty participation in clinical practice generated revenue for their college. Clinical practice was required for promotion by only 16% of the schools and only 15% of the schools required clinical practice for tenure. Pohl and associates (2002) examined the relevance of clinical practice in promotion and tenure decisions. More than 50% of the nursing faculty reported that clinical practice was not considered in promotion and tenure decisions at their institutions. The predictors of tenure included consideration of clinical competence and institutional support for clinical practice.

Nursing and allied health educators are expected to have a comprehensive knowledge of their disciplines in addition to clinical expertise. The faculty spend significant time in the clinical setting supervising students in addition to classroom instruction. Maintaining clinical expertise is a time and energy sapping task, but in general, the criteria for tenure in nursing and allied health education do not reflect the value of clinical practice.

Recent Initiatives Designed to Modify the Tenure System

The current demand for accountability in public institutions of higher learning, championed by politicians, is challenging the relevancy of the tenure system. The criticism has led to the elimination of the tenure system in some colleges and universities (Sullivan, 1996; Gignac et al, 2000). As a result of external pressure from state legislatures and board of trustees, post-tenure review is now mandated in many colleges and universities. Suess (1995) surveyed the attitudes of nursing educators toward post-tenure performance evaluations. The findings revealed that the attitude towards post-tenure review was not significantly related to such variables as tenure status, perceived productivity in teaching, service, scholarship, internal motivation, age, teaching experience, gender, educational qualification, or rank. Faculty overwhelmingly stated that they desire feedback on their work, and were supportive of post-tenure review in their institution.

Reilly et. al. (1996) investigated the use of external review in promotion and tenure decisions in nursing education. Their findings revealed that the majority of the nursing programs surveyed used external review, especially for tenure decisions and promotion to the rank of associate professor and professor. The advantages of external review were felt to far outweigh any disadvantages. Trower (1996) surveyed provost of colleges and universities nationwide to obtain relevant information on the tenure policies, practices, and trends. The study revealed that 31% of the provosts reported no changes to traditional tenure policies; 29% indicated that post-tenure review is being considered in their institutions; 24% have long-term (more than one year) non tenure-track appointments; 15% reported no tenure system in their institutions, but they have contract systems instead; 5% have imposed a tenure quota; 3% reported that tenure is under review in their institutions; 3% indicated that inducements for faculty to forego tenure is being practice and only 2% recently changed the tenure criteria.

Recently, Balogun and Sloan (2005) investigated the tenure policies and practices in allied health and nursing education. The deans of both disciplines had similar views on the tenure system; 75% of allied health deans and 73% of nursing deans support the tenure system. Post-tenure review is practiced in 70% of the allied health programs and in 66% of the nursing programs. An inducement to forgo tenure is practiced in only 4% of the allied health programs and in 11% of the nursing programs. A change in traditional tenure is being considered in only 14% of the allied health programs and in 22% of the nursing programs. In the same vein, tenure quota is imposed in only 7% of the allied health programs and in 10% of nursing programs. A change in the tenure criteria is under review in 42% of the allied health programs and in 38% of the nursing programs. Overall, Balogun and Sloan's (2005) study reported slightly higher percentages in each of the dependent variables monitored in their study when compared to the findings by Trower (1996). The trend in the data suggests an ongoing modification in the practices and policies governing the tenure system.

Conclusion

Although the doctorate is the recognized educational requirement for granting tenure, the national trend is shifting to requiring doctorate in nursing or in specific allied health disciplines. The tenure rate reported by studies published in the 80's and 90's are much higher than the two studies published in the last 5 years; research oriented and private universities had the highest tenure rate. The standard for granting tenure continues to evolve and achieving tenure is tending to be more difficult. As more allied health and nursing educators earn doctorates and become more involved with research, the tenure rate in both fields will increase. The values attached to teaching, scholarship and service are highly dependent on the type and mission of each institution. Teaching is more highly valued in liberal arts colleges and four year universities than in research oriented universities. Nursing and the allied health professions are aiming to fit into the traditional model that emphasizes scholarship in the award of tenure. Although it is generally recognized that clinical skills are central to the practice of all health professions, clinical competence is rarely considered in tenure decisions in both nursing and allied health education. To receive the respect of their peers in academia, we believe the standard for granting tenure in nursing and allied health should closely conform to those of other health professions. The awarding criteria should be the same in intellectual rigor as those in respected health disciplines. Nationwide, there are several initiatives designed to modify the tenure system. Many of the initiatives pose a major challenge to the basic tenets for granting tenure.

Acknowledgements

Many individuals have contributed to the completion of this manuscript and deserves recognition. Ms. Antoinette Smith, Sandra Fuller and Rukiya Akua provided clerical support; Dr. Sallie Tucker-Allen provided technical and editorial assistance in an early draft of the manuscript. We would also like to thank Dr. Elnora D. Daniel, President, Chicago State University, for stimulating our interest in this topic.

References

Adderly-Kelly B. Promoting the scholarship of research for faculty and students. Association of Black Nursing Faculty Journal, 14(2): 41-4, 2003.

Akroyd D, Bamberg WR, Wilson SL, Jones HP. Differences in attitudes regarding teaching and research orientations between allied health faculty and administrators in academic health centers. Journal of Allied Health, 30(2): 61-7, 2001.

Angstadt CN, Nieman LZ, Morahan PS. Strategies to expand the definition of scholarship for the health professions. Journal of Allied Health, 27(3): 157-61, 1998.

Baird SC, Biegel A, Bopp A, Dolphin NW, Ernst N, Hagedorn M, Malkiewicz J, Payton RJ, Sawatzky G. Defining scholarly activity in nursing education. Journal of Nursing Education, 24(4): 143-7, 1985.

Balogun JA, Sloan PE. Emerging trends on tenure policies and practices in nursing and allied health education. Journal of Allied Health, 2005 (In Press).

Balogun JA, Sloan PE, Germain, M. Determinants of tenure in allied health education and nursing education. Nursing Education Perspectives, 2005 (Submitted for Publication).

Balogun JA, Sloan PE, Germain, M. Perspectives of deans of allied health and nursing for tenure. Perceptual and Motor Skills, 2005 (Submitted for Publication).

Barger SE, Nugent KE, Bridges WC. Nursing faculty practice: an organizational perspective. Journal of Professional Nursing, 8(5): 263-70, 1992.

Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. The Carnegie Foundation for the Advancement of Teaching, New Jersey, 1989.

Conine TA, Shilling LM, Pierce ER. The relative importance of supportive data for promotion and tenure reviews. Journal of Allied Health, 14(2): 183-90, 1985.

Flanigan KS, Ballinger PW, Grant HK, Bennett D, Schiller MR, Waller KV, Jordan L, Gierhart J, Brodnik MP, Van Son LG. Research productivity profile of allied health faculty. Journal of Allied Health, 17(2): 87-100, 1988.

Gignac J, Cuellar H, Licata CM. How post tenure review became law: Inside the legislative process in Arizona and Texas. American Association for Higher Education Bulletin, Washington, DC, 3-6, 2000.

Gropper RG. Tenure in Nursing Education: How Are We Doing? Nursing Outlook, 46 (5), 1998.

Herr KA. Faculty practice as a requirement for promotion and tenure: receptivity, risk, and threats perceived. Journal of Nursing Education, 28(8): 347-53, 1989.

Hodges LC, Poteet GW. The first five years after the dissertation. Journal of Professional Nursing, 8 (3): 143-147, 1992.

Holcomb JD Roush RE. A study of the scholarly activities of allied health faculty in southern academic health science centers. Journal of Allied Health, 11: 277-293, 1998.

Holcomb JD. Selker LG. Roush RE. Scholarly productivity: a regional study of physical therapy faculty in schools of allied health. Physical Therapy, 70(2): 118-24, 1990.

Kruger S, Washburn J. Tenure and promotion: an update on university nursing faculty. Journal of Nursing Education, 26(5): 182-8, 1987.

Melland HI. Nurse educators and the demands of research. Journal of Nursing Education, 34(2): 71-6, 1995.

Messmer PR. Factors that affect academic tenure in schools of nursing. University of Pittsburgh Doctoral Dissertation, 1988.

Messmer PR. Academic tenure in schools of nursing. Journal of Professional Nursing, 5(1): 39-48, 1989.

Messmer PR. Why do faculty members get tenure? The dean's perspective. Nurse Education, 16(3): 23-5, 1991.

Moore MN. Tenure and the university reward structure. Nursing Research, 38(2): 111-6, 1989.

Nieswiadomy RM. Nurse educators' involvement in research. Journal of Nursing Education, 23(2): 52-6, 1984.

O'pt Holt TB. A study of tenure among allied health faculty. Journal of Allied Health, 20(4): 245-54, 1991.

Ostmoe PM. Correlates of university nurse faculty publication productivity. Journal of Nursing Education, 25(5): 207-12, 1986.

Perry S. A doctorate--necessary but not sufficient. Nursing Outlook, 30:95-98, 1982.

Pohl JM, Duderstadt K, Tolve-Schoeneberger C, Uphold CR, Hartig MT. Faculty practice: what do the data show? Findings from the National Organization of Nurse Practitioner Faculties Practice Survey. Nursing Outlook, 50(6): 238-46, 2002.

Reilly L, Carlisle J, Mikan K, Goldsmith M. External review for promotion and tenure in schools of nursing. Nurse Education Today, 16(5): 368-72, 1996.

Retrieved September 15, 2005 from http://www.aacn.nche.edu/education/doctoral.htm

Retrieved April 3, 2005 from http://www.bhpr.hrsa.gov.

Schiller MR, Rudge SJ, Ballinger PW. Research activities and interests of dietetic educators. Journal of American Dietetic Association, 88(9): 1070-5, 1988.

Suess LR. Attitudes of nurse-faculty toward post-tenure performance evaluations. Journal of Nursing Education, 34 (1): 25-30, 1995.

Sullivan EJ. Education: Is tenure still viable today? Journal of Professional Nursing, 12 (3): 130, 1996.

Trower CA. Tenure Snapshot. Working Paper Series for the American Association for Higher Education, Washington, DC, 1996.

Waller KV. Karni KR. Wilson SL 1999 Scholarship and research of allied health deans and directors. Journal of Allied Health, 28(1): 1-7, 1999.

Waller KV, Wyatt D, Karni KR. Research productivity and activities of clinical laboratory science faculty: a follow-up study. Journal of Allied Health, 27(3): 142-9, 1998.

Joseph A. Balogun, Chicago State University, IL

Patricia E. Sloan, Chicago State University, IL

Monique Germain, Chicago State University, IL

Joseph Balogun, PT, Ph.D., FACSM, is Professor and Dean, Patricia Sloan, Ed.D., FAAN, is Professor and Assistant Dean, and Monique Germain, M.S, is Assistant Professor, College of Health Sciences.