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practitioner role: individuals perceptions of the lived experience
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Exploring the lecturer/ practitioner role: individuals perceptions of the lived experience Linda Nelson and Robert McSherry
Linda Nelson RGN, DipN, BSc(Hons), MEd, Senior Lecturer, Adult Nursing, University Teesside, School of Health & Social Care, Middlesbrough TS1 3BA, UK. Tel: ;44-(0)1642384964; Fax: ;44(0)1642-384105; E-mail address: linda.nelson@ tees.ac.uk (L. Nelson). Robert McSherry RGN, DipN(Lon), BSc(Hons), MSc, Principal Lecturer, Practice Development, University Teesside, School of Health & Social Care, Middlesbrough, TS1 3BA, UK. Manuscript accepted: 6 March 2002
This study explored the individual experiences of lecturer practitioners during the development of their role while on secondment to a university. The method was an inductive approach influenced by phenomenology using a sample of six qualified nurses from a variety of clinical backgrounds in both the community or hospital settings. Data from the unstructured interviews was collected, recorded and analysed using Burnard’s method of Thematic Content Analysis (Burnard 1991). Common themes emerged highlighting the positive and negative aspects of the lecturer practitioner role; expectations, support, credibility, time-management, and contractual issues. The findings will assist with future role development in the university, provide information for other universities and Trusts considering introduction and development of the role as well as individuals who may be interested in taking up the challenge of the lecturer practitioner post. © 2002 Elsevier Science Ltd. All rights reserved.
Introduction The importance of practitioner involvement in educational programmes is emphasised in recent reports highlighting the partnership between Universities and Trusts/Agencies. This demonstrates a shared commitment to preparing professionals who are fit for purpose, with the skills and knowledge required to provide the best possible care in the health service (UKCC 1999). The lecturer practitioner role is one way of enhancing this partnership as students are taught by staff who are immersed in nursing practice. It is well documented that the role provides the opportunity to bring together theory and practice by maximising students learning in the classroom and practice settings (Shepherd et al. 1999). ‘Making a Difference’ (Department of Health 1999), proposes an increase in lecturer
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practitioner posts. If the latter is to be realised what is required is a focused understanding of the structure and associated issues relating to its development. Issues such as:
Serving two masters and the expectations of giving 100% to each (Rhead & Strange 1996). Guidelines for both the role holder and employing institution. A systematic evaluation of the lecturer practitioner role (Shepherd et al. 1999).
The lecturer practitioner role was introduced into the university three years ago. It was felt timely to undertake a small exploratory study after two years to investigate the ‘lived experience’ of lecturer practitioners during the development of their individual roles.
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Aims of the research The study aimed to:
Explore individual lecturer practitioner experiences of the development of their role. Identify positive and negative factors which have influenced the development of the lecturer practitioner role Formulate recommendations for the future development of the lecturer practitioner role.
Critical analysis of relevant theory A critical review of the literature surrounding the lecturer practitioner role identified four recurring themes associated with defining, role and responsibilities, bridging the perceived theory practice gap and encouraging reflexivity.
Defining the lecturer practitioner role Fitzgerald (1989 p. 13) defines the lecturer practitioner as ‘a senior nurse who has a mastery of practice, education, management and research’ and uses this to develop the skills and knowledge of the nursing staff while acting as a nurse leader. This definition implies seniority of the post holder where by the central element of authority is highlighted to be effective and functional within the role (Champion 1992). Hollingworth (1997 p. 1) recognised this when defining the lecturer practitioner as ‘an individual who has the authority over work organisation, the delivery of care and allocation of resources within a clinical area. In contrast, Burke (1993) argues that the lecturer practitioner’s ability to facilitate change and act as a change agent, is due to an acknowledged position in both settings and seniority of position is unimportant.
Bridging the theory practice gap The potential of the lecturer practitioner role to bridge the gap between theory and practice is well documented (Driver & Campbell 2000). Lecturer practitioner posts stemmed from ‘concern about the difficulties experienced by
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practitioners and educators in finding a match between what was being done in practice and what was being taught in theory, (Vaughan 1990 p. 106). Newman et al. (2001) propose that lecturer practitioners act as a link in bridging and crossing the gap as they work in both practice and academic areas. Shepherd et al. (1999) identified that lecturer practitioner roles facilitate the integration of theory and practice in the community setting a number of ways. Keeping practitioners involved as to the learning needs of students and ensuring staff were up to date and well supported regarding educational issues and assessment. On an individual basis lecturer practitioner’s experiences support the view that the role is a way of bringing together theory and practice and all disciplines of nursing are represented within the literature. (McNally 1994, Gould 1996).
Role and responsibilities The lecturer practitioner role is identified as important in strengthening the link between education and practice (Rigby et al. 1998). Service and education sides must have a clear idea of how the post will work for the post holder as different perceptions will lead to role conflict and confusion (Fairbrother & Ford 1998). Jones (1996) explored the lecturer practitioner role from a management perspective finding that they improved standards of practice and developed closer links with education. This required them to have jointly planned and set objectives, between service and education as pressures included trying to divide hours evenly between two organisations. Willis (1998) identified the value of the lecturer practitioner role in supporting mentors in the clinical setting and this is supported by McNally’s (1994) experience. Dampier & Ford (1997) describe how they encourage and support research projects, actively teach clinical staff by running workshops and facilitate changes in practice by training staff in standard setting.
Encouraging and supporting reflexivity Reflection is a vital necessity if learning is to occur from practice (Benner 1984) and lecturer
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practitioners are situated to encourage reflection in both teaching and practice roles. During clinical input they reflect in and upon practice, translating this information back through the medium of lectures. The lecturer practitioner in exposing an experience by reflection illustrates a theoretical basis for their action, and can then refine this action in future practice (Rhead & Strange 1996). Experiential knowledge helps students to acquire an understanding of events and interactions, and this knowledge is developed through reflection on action in a given situation. Dale (1994) sees the development of this experiential knowledge as a challenge for educationalists and believes that this is achieved when nurse teachers work alongside students in practice delivering hands-on care. In summary, the lecturer practitioner role has developed as a way of bridging the gap between theory and practice with an equal responsibility to both service and education. There is an abundance of literature surrounding the theory to practice gap however there is limited evidence in relation to the individual experiences of lecturer practitioners during the development of their role. A recent recommendation by Aston et al. (2000) identified the need for further research in this area. This lack of evidence strongly supports the need for this study.
Methodology All paradigms create knowledge that can describe and explain the phenomena being studied and it is the type of knowledge needed, which will be the determining factor in the choice of research approach (Harper & Hartmann 1997). The aim of this study was to explore and describe the experience of individual lecturer practitioners in the development of their role and this falls within the interpretive paradigm.
Sample A purposeful sample of six participants were selected based on their experience of developing a lecturer practitioner role. All had been in post for a minimum of six months with a fifty–fifty division of time between education
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and practice. Each had different clinical backgrounds in either community or hospital settings. It is acknowledged that the sample size was small, but the in-depth nature of the study would provide considerable data. Patton (1990 p. 169) states that ‘information rich cases are those from which one can learn a great deal about issues of central importance to the purpose of the research’.
Ethical considerations Participants were initially contacted, the aims of the study discussed and consent obtained to take part. Prior to the interview taking place verbal consent was sought. The option to withdraw without penalty was seen as essential due to the voluntary nature of participation in the study (Burns & Grove 1995). Participants were allocated a number from one through to six and this appeared on the tape with the name stored in a separate place for reference. Streubert & Carpenter (1995) believe that this helps to ensure identity of the participants is not revealed.
Data collection Data was collected by the use of audio taped unstructured interviews, which was seen as a suitable method for qualitative work using a phenomenological approach (Morse 1994). The purpose of the interview was to understand shared meanings by drawing from participants a description of their ‘lived experience’ as a lecturer practitioner. Participants told their stories and described their experiences in a narrative fashion.
Data analysis Qualitative methods produce rich amounts of data which needs to be systematically analysed in a logical fashion (Miles & Huberman 1994). Data was analysed using a process of thematic content analysis developed by Burnard (1991). Each audio tape was transcribed within fortyeight hours of the interview as recommended by Streubert & Carpenter (1995) who suggest that early transcription of the data familiarises the researcher with emerging concepts and categories.
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Issues of rigour Burnard (1991) explicitly addresses issues relating to validity and for the purpose of this study these stages were followed. First a colleague read through three transcripts separately and identified an independent category system. This was then compared with the researchers and categories distilled down to a smaller number by the process of ‘collapsing’. During the second check for validity, three participants were asked to read through the transcript of their own interview and identify what they saw as the main themes that emerged. Valid or true analyses are achieved through the involvement of the
PRINCIPAL
participants, and it is they who actually confer validity on the researcher’s analyses. This approach to data analysis intended to enhance the rigour of the study by ensuring the trustworthiness, credibility and reliability of the method and findings of the study.
Results: identifying the themes Core themes were identified by the application of Burnard’s (1991) thematic content analysis approach to data transcribing and analysis. The undertaking of this specific sequential process revealed five principal and seventeen sub categories Fig. 1.
SUB CATEGORIES
CATEGORIES EXPECTATIONS
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LP role would develop in University and Practice area
SUPPORT
CREDIBILITY
TIME MANAGEMENT
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Teaching skills to pre-registration students
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Steep learning curve
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Peer support from other LPs
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Support from practice
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Support from academics
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Integrate theory and practice
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Clinically credible
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Increased with clinical staff
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Link between University and practice
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Lack of time-management skills
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Enormous stress in LP role
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Role conflict
CONTRACTUAL ISSUES -
Lack of structure No communication between university and practice
Fig. 1.
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Need for joint personal development plans
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Two parts – two masters
Principal and sub categories associated with the LP role.
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Discussion of key findings The findings are presented in themes and interpretive comments are included. Sandelowski (1994) suggests that using direct quotes gives insight into people’s real experiences and illustrates the arguments.
Expectations A theme that emerged was lecturer practitioners expectations of how their role would develop in both university and practice arenas. Their present role in practice remained unchanged with the same responsibilities and commitments. However, as one lecturer practitioner stated “I would have liked to have seen some research going on or practice based teaching, that sort of thing”. These expectations are supported within the literature as it is recognised that the role has the potential to develop practice in the clinical area and research is viewed as an important element of the role (Gould 1996). In contrast to previous findings, lecturer practitioners described how this has yet to be achieved and this was perceived as a negative factor in the development of their role. The role within the university had involved teaching skills to pre-registration students and lecturer practitioners expressed a firm belief that this was a valuable contribution to nursing education. It has been suggested that the role is the solution to marrying ‘knowing how’ – the ability to perform practical tasks to ‘knowing that’ – the knowledge to describe the rationale behind the task (Rhead & Strange 1996). These lecturer practitioners had the opportunity to bring together both ‘practical’ and ‘propositional’ knowledge to the learning situation (Heron 1982). This was particularly enhanced when skills were matched to clinical expertise. All were highly motivated individuals with a personal determination to succeed in the development of their role. The learning curve had been steep, although worse than anticipated. Despite the ‘steep’ or even ‘vertical’ learning curve, the experience was viewed as a challenge. However motivation began to wane as the experience of fulfilling the demands of the lecturer practitioner role continued.
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For example: “It’s a good job but its damned hard. If I continue like this I will probably burn out in a couple of months time or in the very near future”. The length of time an individual could sustain the pressures of the role was discussed by all the lecturer practitioners interviewed, in particular that they did not envisage ‘doing it long-term’.
Support Supportive networks have found to be effective in coping with stressful situations (Cox 1991). Cohen and Willis (1985) identified that a major life stressor is almost certainly more bearable if social and emotional support is available. All participants felt it was essential to have support during the development of the role and as an ongoing process. Peer support had been the strongest experienced by all participants. They described ‘shared experiences’ and felt it was only those who had experienced the lecturer practitioner role who could fully understand the difficulties and as such share anxieties and problems. Support from colleagues in practice brought mixed experiences. Initially some gained confidence from peers when they doubted their ability to fulfil the role: “They couldn’t really see me having a problem with it. They were very supportive and very encouraging and say to me, of course you can do it.” (Lecturer practitioner) However, for others there was a distinct lack of support. The lecturer practitioners believed this was due to lack of knowledge in relation to the role and it was suggested that it is seen as two separate posts with little understanding of the responsibilities the role carries. For those in senior positions in practice, support was less forthcoming as the time in post went on. Colleagues resented their changing role and reduced time in the clinical area, as they perceived this led to a lack of leadership and guidance. Fitzgerald’s (1989) definition of the lecturer practitioner stresses the importance of the role
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requiring a senior nurse who acts as a nurse leader. But in contrast the findings from this study identified that the seniority of the post holder led to the role functioning less effectively. When lecturer practitioners are managers in clinical practice their ‘expertise’ are a considerable loss to the clinical environment once hours are reduced. The lecturer practitioners identified minimal support from university staff during the development of their roles and similar to practice, it was felt this was due to a lack of knowledge regarding their role and responsibilities. Those who had been supportive worked with the lecturer practitioners in teaching skills to students and valued their clinical expertise and contributions. The lecturer practitioners expected their role to be complementary to the Senior Lecturer role in facilitating students learning by utilising their clinical expertise to support theoretical input. They described how both do very different things with very different expertise: “Senior Lecturers do things that I would find difficult and maybe that I wouldn’t have the experience to get across to students. I also do things that they would find difficult. Together the roles complement each other.” (Lecturer practitioner) It can be concluded that from the descriptions there is a distinct lack of knowledge from both university and practice regarding the lecturer practitioner role and this needs to be addressed in future development for the role to be successful. Unless there is adequate support from both service and education as suggested by Lathlean (1995) the role will fail.
Credibility Participants believed that the role had provided the opportunity to bring together both theory and practice and these results support the findings from many previous studies (Willis 1998). All lecturer practitioners felt this was due to being able to support teaching with recent examples from practice or
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as one lecturer practitioner put it: “What we teach on the morning we could be doing in the afternoon.” The lecturer practitioners were reflecting in and upon practice and then translating this information back within the classroom setting. This was followed up in the clinical area by encouraging students to reflect on their own practice by recognising the application of underpinning theory. They were also facilitating student learning through discussion of current practical experience in both university and clinical settings. Linking theory to practice through reflective activities is a major role for nurse teachers (Crotty 1993) and these findings identify this as a positive factor in the development of lecturer practitioner roles. The lecturer practitioners in this study felt their joint role made teaching ‘easier’ for them as they had equal time in both areas. All believed that recent experience made them ‘clinically credible’ in the eyes of pre-registration students. All expressed their belief that students viewed them as clinically credible and this was due to their still having a ‘foot’ in practice and ‘being out there’ doing the job in the ‘real world’. It was suggested that students believe you know what you are talking about simply because you are a practitioner and all felt students valued the development of the role: “They respect the fact that you are a practitioner as well as a teacher. It’s good for the role of the nurse, it’s good for the way students see nursing.” All lecturer practitioners felt their credibility had increased in the clinical area and this was viewed as a positive factor. The role acted as a link between practice and the university. A major part of the role is keeping practitioners involved with the learning needs of students (Shepherd et al. 1999). The findings from this study support this however participants believed their credibility in the clinical area only developed once they were able to demonstrate the benefits of the lecturer practitioner role to peers in practice.
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Time management Time management skills were seen as essential to the development of the role but all commented that this was a quality they did not possess. The competing roles of university and practice had placed great demands on time and this was viewed as a negative factor that had contributed to the development of their role. Participants described how they initially took on too many teaching commitments and it was recognised that this was due to their lack of knowledge and inability to refuse teaching hours. However two suggested they were fully aware of being over committed. For example: “I’ve been asked to teach certain skills workshops and I get bogged down. Maybe it’s my fault because I don’t say ‘no’. You want to impress and to be seen as good in a new job, so you daren’t say ‘no’. My contract is so short and I therefore take on as much as I can.” (Lecturer practitioner) They expressed a need to prove themselves and expected this to involve working under excessive pressure. The literature surrounding the role had identified the need for good timemanagement skills and the ability to prioritise demands as being essential (Rigby et al. 1998), without them the lecturer practitioner would face enormous pressure trying to meet the requirements of ‘two masters’. They were also working at home in their own time to fulfil the demands of both university and practice. One lecturer practitioner expressed this as: “I spend my time either thinking, I’m never going to have time to do everything, or there must be something I can do easier than this which isn’t as much hassle. I feel that in the near future one side will have to go because I can’t do both sides as effectively as I want to.” Reduced time in the practice area had resulted in the lecturer practitioners being unable to take on the same responsibilities, yet practitioners still had the same expectations. Fulfilling the expectations of both service and education sides of the equation had been problematic. Demands had led them to question their ability to continue as they
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perceived they were not being effective in either role. Many lecturer practitioner posts have failed because of the pull in opposite directions (Murray & Thomas 1998). Timemanagement skills had improved with experience and the length of time in post. Either time was managed more effectively in the clinical area or the lecturer practitioners refused to take on teaching commitments they could not fulfil.
Contractual issues The lecturer practitioners felt that there was little structured support during the development of their role in the university and this was perceived to be a negative factor. The induction programme was described as ‘inadequate’. All were allocated a named mentor but experienced difficulties in accessing them and consequently this had proved to be of little benefit. Implicit within the responses was that this does need to be addressed as a thorough induction to people and personnel in both environments would provide role identity for individuals coming into post. They identified a distinct lack of communication between education and practice regarding their responsibilities in the opposite area: “There is no insight into the role from practice and no consideration from the university as to what you do in practice.” They emphasised the need for joint personal development plans (PDP) and felt that this was the solution to enhancing communication between the university and practice. If perceptions of the role differ between managers in university and practice there is a huge potential for role conflict and confusion. A danger that is clearly recognised in the literature (Murray & Thomas 1998). Lecturer practitioners questioned their two job descriptions, and it was felt that this enhanced the divide between the posts leading to the role being seen as ‘two parts’ with ‘two masters’, i.e. “The job description should be for one person, not half and half. I am a whole person.” (Lecturer practitioner)
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As the lecturer practitioner role is a joint initiative between service and education this would avoid some of the above dangers as it would identify clear responsibilities in service and education for the role holder. A more defined role is required to facilitate future development (Lee 1993). There are many factors surrounding contractual issues which have been influential in the development of the lecturer practitioner role, however despite these difficulties participants still believed that the role is the way forward in nursing education: “It’s a brilliant idea but there needs to be a lot more discussion about the role and its development, problems we’re having now we need to reflect on so we can move on.” (Lecturer practitioner) Although this was a small study the results have identified many positive and negative factors that have influenced the development of the lecturer practitioner role.
Conclusion The literature surrounding the development of the role is vast in relation to the potential to close the gap between theory and practice and the findings from this study firmly support this (Thompson et al. 1998). Lecturer practitioner initiatives are an exciting educational strategy that can contribute to the bridging of the theory-practice gap in both academic and clinical environments as they have the potential to facilitate learning by working with students and mentors in practical and theoretical settings. It has been suggested that the uniqueness of nurse education is its ability to produce autonomous, knowledgeable and reflective health care professionals (Department of Health 1999). The role provides the opportunity to maximise students learning in both environments through reflection in and upon practice. The potential for the lecturer practitioner to contribute to the educational needs of practitioners is also a positive aspect of the development of the role. Post registration education is perceived to be of equal importance as the knowledge and skills
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they develop in the university are utilised and shared with the practice area (Jones 1996). There is a distinct lack of knowledge from both university and practice regarding the roles and responsibilities of the lecturer practitioner in the opposite setting. This is contributing to role conflict and increased stress (Woodrow 1994). This could be explained by the ‘newness’ of the role as few people have a total picture of what lecturer practitioners do in either setting. It is important for managers to work together as this will also ensure that everyone is aware of the heavy workload that each side can present. The diversity of the role requires strong support strategies from both organisations (Thompson et al. 1998). Despite the difficulties the participants in this study believe that the lecturer practitioner role is valuable and a way forward in nursing education for both pre and post registration students. Lecturer practitioner’s gained a wealth of experience and were able to continue to develop clinical skills in the practice area whilst learning new teaching and academic skills in the university. Considering the complexity of the role the issue of how to prepare individual lecturer practitioners for the role must be addressed to utilise them effectively in both areas (Rhead & Strange 1996). The lecturer practitioner role is an exciting innovation that can straddle the worlds of higher education and practice (Shepherd et al. 1999). As such it is a post worthy of investment, planning and preparation in order to fulfil the potential and maximise the benefits. The findings from this study suggest that if this is not achieved, then the potential of the role for uniting theory and practice within nursing education will be lost.
Limitations The research approach achieved the aims of the study. The small number of participants and absence of systematic sampling characteristic of qualitative research means a lack of generalisability becomes a limitation (Bryman 1988). This sample was drawn from only one university and as such findings reflect that location and may not have application to other universities. The goal of naturalistic inquiry is not for generalisation (Lincoln &
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Guba 1985) but rather to unveil the nature, essences, characteristics and meanings of phenomena as fully and completely as possible, and within particular contexts. The expectations for determining whether the findings are transferable rests with the potential user of the findings and not with the researcher (Lincoln & Guba 1985).
Recommendations for practice One of the original aims of this study was to formulate recommendations to inform the development of future lecturer practitioner roles as this requires structure and understanding. Although this project was small the findings will be a valuable contribution to the future development of the role in the university and in practice if the following recommendations are actioned. There needs to be a clear focus for each lecturer practitioner introduced into the university where the role, responsibilities and expectations are clearly identified in both areas. This will aid introduction and acceptance of the role by colleagues. Joint Personal Development Plans involving managers from university and practice should be undertaken, where a designated period of time for educational development for the lecturer practitioner is agreed. A full induction into the university is essential along with the promotion of the role and responsibilities of the lecturer practitioner in raising awareness of the role. Lecturer practitioners should be practising clinicians delivering theoretical and clinical skills development around their area of expertise. A collaborative working group comprising of academic and clinical representatives including lecturer practitioners should be established to encourage networking and to ensure monitoring and evaluation of the role. References Aston L, Mallik M, Day C, Fraser 2000 An exploration into the role of the teacher/lecturer in practice: findings from a case study in adult nursing. Nurse Education Today 20:178–188 Benner P 1984 From novice to expert: excellence and power in clinical nursing. Addison-Wesley, USA Bryman A 1988 Quantity and quality in social research. Unwin Hyman, London
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Burke IM 1993 the future of the specialist nurse teacher: two different models explored. Nurse Education Today 13:40–46 Burnard P 1991 A method of analysing interview transcripts in qualitative research. Nurse Education Today 11:461–466 Burns N, Grove S 1995 Understanding nursing research. WB Saunders, Philadelphia Champion R 1992 Professional collaboration: the lecturer practitioner role. In: Bines DAW, Watson D (eds) Developing professional education. Society for Research into Higher Education and Open University Press. Milton Keynes Cohen S, Wills TA 1985 Stress, social support and the buffering hypothesis. Psychological Bulletin 98:310–337 Cox T 1991 Stress. Macmillan, London Crotty M 1993 Clinical role activities of nurse teachers in Project 2000 programmes. Journal of Advanced Nursing 18:460–464 Dale AE 1994 The theory – theory gap: the challenge for nurse teachers. Journal of Advanced Nursing 20:521–524 Dampier S, Ford S 1997 Education and practice: a partnership. Paediatric Nursing 9(9):17–18 Department of Health 1999 Making a difference. Strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Home Office, London Driver J, Campbell J 2000 An evaluation of the impact of lecturer practitioners on learning. British Journal of Nursing 9(5):293–300 Fairbrother P, Ford S 1998 Lecturer practitioners: a literature review. Journal of Advanced Nursing 27:274–279 Fitzgerald MC 1998 Lecturer practitioner: action researcher. In: Fairbrother P, Ford S, Lecturer practitioners: a literature review. Journal of Advanced Nursing. 27: pp. 274–279 Gould BH 1996 The lecturer-practitioner role in mental health. Professional Nurse 11(8):549–551 Harper M, Hartmann N 1997 Research paradigms In: Smith P, Hunt JM (eds). Research mindedness for practice. An interactive approach for nursing and health care. Churchill Livingstone, London Heron J 1982 Experiential Training Techniques 2nd edition Human Potential Research Project. University of Guildford, Surrey Hollingworth S 1997 Lecturer Practitioner roles in England. A report prepared for the nursing officer, Director of Nursing. Leeds NHS Direct. June Jones HM 1996 Introducing a lecturer—practitioner: the management perspective. Journal of Nursing Management 4:337–345 Lathlean J 1995 The application and development of lecturer practitioner roles in nursing. Ashdale Press, London Lee P 1993 Education in Practice. Child Health 1(4):151–153 Lincoln YS, Guba EG 1985 Naturalistic inquiry. Sage, Newbury Park McNally S 1994 Role of the lecturer-practitioner in learning disability nursing. British Journal of Nursing 3(5):230–232
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Miles MB, Huberman AM 1994 Qualitative data analysis. 2nd edition. Sage Publications, California Morse JM 1994 Critical issues in qualitative research methods. Sage Publications, London Murray C, Thomas M 1998 How can the clinical credibility of nurse lecturers be improved?: 2 British Journal of Nursing 7(19):1169–1170 Newman M, Hayes N, Sugden M 2001 ‘Evidence-based practice: a framework for the role of the lecturerpractitioner’ Clinical Effectiveness in Nursing 5:26–29 Patton M 1990 Qualitative Evaluation and Research Methods. Sage, California Rhead M, Strange F 1996 Nursing lecturer/practitioners: can lecturer/practitioners be music to our ears? Journal of Advanced Nursing 24:1265–1272 Rigby P, Ford J, Holding D 1998 An initiative in mental health nursing. Nursing Management 5(2):9–11 Sandelowski M 1994 Notes on transcription research in nursing and health 17:311–314 Shepherd B, Thomson AM, Davies S, Whittaker K 1999 Facilitating learning in the community with
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lecturer-practitioner posts. Nurse Education Today 19:373–385 Streubert HJ, Carpenter DR 1995 Qualitative research in nursing. Advancing the humanistic imperative. Lippincott, Philadelphia Thompson J, Thomson AM, Shepherd B 1998 An evaluation of the lecturer-practitioner role in the Manchester College of Midwifery and Nursing. Occasional paper No 4. School of Nursing, University of Manchester UKCC 1999 United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1999 fitness for practice. UKCC Vaughan B 1990 Knowing that and knowing how: the role of the lecturer/practitioner. In: Models for nursing practice. Scutari Press, London Willis J 1998 Lecturer-practitioners: serving two masters for a common cause. Nursing Times Learning Curve 1(12):6–7 Woodrow P 1994 Role of the lecturer practitioner. British Journal of Nursing 3(11):571–575
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Article
Exploring the lecturer/ practitioner role: individuals perceptions of the lived experience Linda Nelson and Robert McSherry
Linda Nelson RGN, DipN, BSc(Hons), MEd, Senior Lecturer, Adult Nursing, University Teesside, School of Health & Social Care, Middlesbrough TS1 3BA, UK. Tel: ;44-(0)1642384964; Fax: ;44(0)1642-384105; E-mail address: linda.nelson@ tees.ac.uk (L. Nelson). Robert McSherry RGN, DipN(Lon), BSc(Hons), MSc, Principal Lecturer, Practice Development, University Teesside, School of Health & Social Care, Middlesbrough, TS1 3BA, UK. Manuscript accepted: 6 March 2002
This study explored the individual experiences of lecturer practitioners during the development of their role while on secondment to a university. The method was an inductive approach influenced by phenomenology using a sample of six qualified nurses from a variety of clinical backgrounds in both the community or hospital settings. Data from the unstructured interviews was collected, recorded and analysed using Burnard’s method of Thematic Content Analysis (Burnard 1991). Common themes emerged highlighting the positive and negative aspects of the lecturer practitioner role; expectations, support, credibility, time-management, and contractual issues. The findings will assist with future role development in the university, provide information for other universities and Trusts considering introduction and development of the role as well as individuals who may be interested in taking up the challenge of the lecturer practitioner post. © 2002 Elsevier Science Ltd. All rights reserved.
Introduction The importance of practitioner involvement in educational programmes is emphasised in recent reports highlighting the partnership between Universities and Trusts/Agencies. This demonstrates a shared commitment to preparing professionals who are fit for purpose, with the skills and knowledge required to provide the best possible care in the health service (UKCC 1999). The lecturer practitioner role is one way of enhancing this partnership as students are taught by staff who are immersed in nursing practice. It is well documented that the role provides the opportunity to bring together theory and practice by maximising students learning in the classroom and practice settings (Shepherd et al. 1999). ‘Making a Difference’ (Department of Health 1999), proposes an increase in lecturer
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practitioner posts. If the latter is to be realised what is required is a focused understanding of the structure and associated issues relating to its development. Issues such as:
Serving two masters and the expectations of giving 100% to each (Rhead & Strange 1996). Guidelines for both the role holder and employing institution. A systematic evaluation of the lecturer practitioner role (Shepherd et al. 1999).
The lecturer practitioner role was introduced into the university three years ago. It was felt timely to undertake a small exploratory study after two years to investigate the ‘lived experience’ of lecturer practitioners during the development of their individual roles.
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Aims of the research The study aimed to:
Explore individual lecturer practitioner experiences of the development of their role. Identify positive and negative factors which have influenced the development of the lecturer practitioner role Formulate recommendations for the future development of the lecturer practitioner role.
Critical analysis of relevant theory A critical review of the literature surrounding the lecturer practitioner role identified four recurring themes associated with defining, role and responsibilities, bridging the perceived theory practice gap and encouraging reflexivity.
Defining the lecturer practitioner role Fitzgerald (1989 p. 13) defines the lecturer practitioner as ‘a senior nurse who has a mastery of practice, education, management and research’ and uses this to develop the skills and knowledge of the nursing staff while acting as a nurse leader. This definition implies seniority of the post holder where by the central element of authority is highlighted to be effective and functional within the role (Champion 1992). Hollingworth (1997 p. 1) recognised this when defining the lecturer practitioner as ‘an individual who has the authority over work organisation, the delivery of care and allocation of resources within a clinical area. In contrast, Burke (1993) argues that the lecturer practitioner’s ability to facilitate change and act as a change agent, is due to an acknowledged position in both settings and seniority of position is unimportant.
Bridging the theory practice gap The potential of the lecturer practitioner role to bridge the gap between theory and practice is well documented (Driver & Campbell 2000). Lecturer practitioner posts stemmed from ‘concern about the difficulties experienced by
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practitioners and educators in finding a match between what was being done in practice and what was being taught in theory, (Vaughan 1990 p. 106). Newman et al. (2001) propose that lecturer practitioners act as a link in bridging and crossing the gap as they work in both practice and academic areas. Shepherd et al. (1999) identified that lecturer practitioner roles facilitate the integration of theory and practice in the community setting a number of ways. Keeping practitioners involved as to the learning needs of students and ensuring staff were up to date and well supported regarding educational issues and assessment. On an individual basis lecturer practitioner’s experiences support the view that the role is a way of bringing together theory and practice and all disciplines of nursing are represented within the literature. (McNally 1994, Gould 1996).
Role and responsibilities The lecturer practitioner role is identified as important in strengthening the link between education and practice (Rigby et al. 1998). Service and education sides must have a clear idea of how the post will work for the post holder as different perceptions will lead to role conflict and confusion (Fairbrother & Ford 1998). Jones (1996) explored the lecturer practitioner role from a management perspective finding that they improved standards of practice and developed closer links with education. This required them to have jointly planned and set objectives, between service and education as pressures included trying to divide hours evenly between two organisations. Willis (1998) identified the value of the lecturer practitioner role in supporting mentors in the clinical setting and this is supported by McNally’s (1994) experience. Dampier & Ford (1997) describe how they encourage and support research projects, actively teach clinical staff by running workshops and facilitate changes in practice by training staff in standard setting.
Encouraging and supporting reflexivity Reflection is a vital necessity if learning is to occur from practice (Benner 1984) and lecturer
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practitioners are situated to encourage reflection in both teaching and practice roles. During clinical input they reflect in and upon practice, translating this information back through the medium of lectures. The lecturer practitioner in exposing an experience by reflection illustrates a theoretical basis for their action, and can then refine this action in future practice (Rhead & Strange 1996). Experiential knowledge helps students to acquire an understanding of events and interactions, and this knowledge is developed through reflection on action in a given situation. Dale (1994) sees the development of this experiential knowledge as a challenge for educationalists and believes that this is achieved when nurse teachers work alongside students in practice delivering hands-on care. In summary, the lecturer practitioner role has developed as a way of bridging the gap between theory and practice with an equal responsibility to both service and education. There is an abundance of literature surrounding the theory to practice gap however there is limited evidence in relation to the individual experiences of lecturer practitioners during the development of their role. A recent recommendation by Aston et al. (2000) identified the need for further research in this area. This lack of evidence strongly supports the need for this study.
Methodology All paradigms create knowledge that can describe and explain the phenomena being studied and it is the type of knowledge needed, which will be the determining factor in the choice of research approach (Harper & Hartmann 1997). The aim of this study was to explore and describe the experience of individual lecturer practitioners in the development of their role and this falls within the interpretive paradigm.
Sample A purposeful sample of six participants were selected based on their experience of developing a lecturer practitioner role. All had been in post for a minimum of six months with a fifty–fifty division of time between education
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and practice. Each had different clinical backgrounds in either community or hospital settings. It is acknowledged that the sample size was small, but the in-depth nature of the study would provide considerable data. Patton (1990 p. 169) states that ‘information rich cases are those from which one can learn a great deal about issues of central importance to the purpose of the research’.
Ethical considerations Participants were initially contacted, the aims of the study discussed and consent obtained to take part. Prior to the interview taking place verbal consent was sought. The option to withdraw without penalty was seen as essential due to the voluntary nature of participation in the study (Burns & Grove 1995). Participants were allocated a number from one through to six and this appeared on the tape with the name stored in a separate place for reference. Streubert & Carpenter (1995) believe that this helps to ensure identity of the participants is not revealed.
Data collection Data was collected by the use of audio taped unstructured interviews, which was seen as a suitable method for qualitative work using a phenomenological approach (Morse 1994). The purpose of the interview was to understand shared meanings by drawing from participants a description of their ‘lived experience’ as a lecturer practitioner. Participants told their stories and described their experiences in a narrative fashion.
Data analysis Qualitative methods produce rich amounts of data which needs to be systematically analysed in a logical fashion (Miles & Huberman 1994). Data was analysed using a process of thematic content analysis developed by Burnard (1991). Each audio tape was transcribed within fortyeight hours of the interview as recommended by Streubert & Carpenter (1995) who suggest that early transcription of the data familiarises the researcher with emerging concepts and categories.
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Issues of rigour Burnard (1991) explicitly addresses issues relating to validity and for the purpose of this study these stages were followed. First a colleague read through three transcripts separately and identified an independent category system. This was then compared with the researchers and categories distilled down to a smaller number by the process of ‘collapsing’. During the second check for validity, three participants were asked to read through the transcript of their own interview and identify what they saw as the main themes that emerged. Valid or true analyses are achieved through the involvement of the
PRINCIPAL
participants, and it is they who actually confer validity on the researcher’s analyses. This approach to data analysis intended to enhance the rigour of the study by ensuring the trustworthiness, credibility and reliability of the method and findings of the study.
Results: identifying the themes Core themes were identified by the application of Burnard’s (1991) thematic content analysis approach to data transcribing and analysis. The undertaking of this specific sequential process revealed five principal and seventeen sub categories Fig. 1.
SUB CATEGORIES
CATEGORIES EXPECTATIONS
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LP role would develop in University and Practice area
SUPPORT
CREDIBILITY
TIME MANAGEMENT
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Teaching skills to pre-registration students
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Steep learning curve
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Peer support from other LPs
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Support from practice
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Support from academics
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Integrate theory and practice
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Clinically credible
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Increased with clinical staff
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Link between University and practice
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Lack of time-management skills
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Enormous stress in LP role
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Role conflict
CONTRACTUAL ISSUES -
Lack of structure No communication between university and practice
Fig. 1.
112
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Need for joint personal development plans
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Two parts – two masters
Principal and sub categories associated with the LP role.
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Discussion of key findings The findings are presented in themes and interpretive comments are included. Sandelowski (1994) suggests that using direct quotes gives insight into people’s real experiences and illustrates the arguments.
Expectations A theme that emerged was lecturer practitioners expectations of how their role would develop in both university and practice arenas. Their present role in practice remained unchanged with the same responsibilities and commitments. However, as one lecturer practitioner stated “I would have liked to have seen some research going on or practice based teaching, that sort of thing”. These expectations are supported within the literature as it is recognised that the role has the potential to develop practice in the clinical area and research is viewed as an important element of the role (Gould 1996). In contrast to previous findings, lecturer practitioners described how this has yet to be achieved and this was perceived as a negative factor in the development of their role. The role within the university had involved teaching skills to pre-registration students and lecturer practitioners expressed a firm belief that this was a valuable contribution to nursing education. It has been suggested that the role is the solution to marrying ‘knowing how’ – the ability to perform practical tasks to ‘knowing that’ – the knowledge to describe the rationale behind the task (Rhead & Strange 1996). These lecturer practitioners had the opportunity to bring together both ‘practical’ and ‘propositional’ knowledge to the learning situation (Heron 1982). This was particularly enhanced when skills were matched to clinical expertise. All were highly motivated individuals with a personal determination to succeed in the development of their role. The learning curve had been steep, although worse than anticipated. Despite the ‘steep’ or even ‘vertical’ learning curve, the experience was viewed as a challenge. However motivation began to wane as the experience of fulfilling the demands of the lecturer practitioner role continued.
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For example: “It’s a good job but its damned hard. If I continue like this I will probably burn out in a couple of months time or in the very near future”. The length of time an individual could sustain the pressures of the role was discussed by all the lecturer practitioners interviewed, in particular that they did not envisage ‘doing it long-term’.
Support Supportive networks have found to be effective in coping with stressful situations (Cox 1991). Cohen and Willis (1985) identified that a major life stressor is almost certainly more bearable if social and emotional support is available. All participants felt it was essential to have support during the development of the role and as an ongoing process. Peer support had been the strongest experienced by all participants. They described ‘shared experiences’ and felt it was only those who had experienced the lecturer practitioner role who could fully understand the difficulties and as such share anxieties and problems. Support from colleagues in practice brought mixed experiences. Initially some gained confidence from peers when they doubted their ability to fulfil the role: “They couldn’t really see me having a problem with it. They were very supportive and very encouraging and say to me, of course you can do it.” (Lecturer practitioner) However, for others there was a distinct lack of support. The lecturer practitioners believed this was due to lack of knowledge in relation to the role and it was suggested that it is seen as two separate posts with little understanding of the responsibilities the role carries. For those in senior positions in practice, support was less forthcoming as the time in post went on. Colleagues resented their changing role and reduced time in the clinical area, as they perceived this led to a lack of leadership and guidance. Fitzgerald’s (1989) definition of the lecturer practitioner stresses the importance of the role
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requiring a senior nurse who acts as a nurse leader. But in contrast the findings from this study identified that the seniority of the post holder led to the role functioning less effectively. When lecturer practitioners are managers in clinical practice their ‘expertise’ are a considerable loss to the clinical environment once hours are reduced. The lecturer practitioners identified minimal support from university staff during the development of their roles and similar to practice, it was felt this was due to a lack of knowledge regarding their role and responsibilities. Those who had been supportive worked with the lecturer practitioners in teaching skills to students and valued their clinical expertise and contributions. The lecturer practitioners expected their role to be complementary to the Senior Lecturer role in facilitating students learning by utilising their clinical expertise to support theoretical input. They described how both do very different things with very different expertise: “Senior Lecturers do things that I would find difficult and maybe that I wouldn’t have the experience to get across to students. I also do things that they would find difficult. Together the roles complement each other.” (Lecturer practitioner) It can be concluded that from the descriptions there is a distinct lack of knowledge from both university and practice regarding the lecturer practitioner role and this needs to be addressed in future development for the role to be successful. Unless there is adequate support from both service and education as suggested by Lathlean (1995) the role will fail.
Credibility Participants believed that the role had provided the opportunity to bring together both theory and practice and these results support the findings from many previous studies (Willis 1998). All lecturer practitioners felt this was due to being able to support teaching with recent examples from practice or
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as one lecturer practitioner put it: “What we teach on the morning we could be doing in the afternoon.” The lecturer practitioners were reflecting in and upon practice and then translating this information back within the classroom setting. This was followed up in the clinical area by encouraging students to reflect on their own practice by recognising the application of underpinning theory. They were also facilitating student learning through discussion of current practical experience in both university and clinical settings. Linking theory to practice through reflective activities is a major role for nurse teachers (Crotty 1993) and these findings identify this as a positive factor in the development of lecturer practitioner roles. The lecturer practitioners in this study felt their joint role made teaching ‘easier’ for them as they had equal time in both areas. All believed that recent experience made them ‘clinically credible’ in the eyes of pre-registration students. All expressed their belief that students viewed them as clinically credible and this was due to their still having a ‘foot’ in practice and ‘being out there’ doing the job in the ‘real world’. It was suggested that students believe you know what you are talking about simply because you are a practitioner and all felt students valued the development of the role: “They respect the fact that you are a practitioner as well as a teacher. It’s good for the role of the nurse, it’s good for the way students see nursing.” All lecturer practitioners felt their credibility had increased in the clinical area and this was viewed as a positive factor. The role acted as a link between practice and the university. A major part of the role is keeping practitioners involved with the learning needs of students (Shepherd et al. 1999). The findings from this study support this however participants believed their credibility in the clinical area only developed once they were able to demonstrate the benefits of the lecturer practitioner role to peers in practice.
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Time management Time management skills were seen as essential to the development of the role but all commented that this was a quality they did not possess. The competing roles of university and practice had placed great demands on time and this was viewed as a negative factor that had contributed to the development of their role. Participants described how they initially took on too many teaching commitments and it was recognised that this was due to their lack of knowledge and inability to refuse teaching hours. However two suggested they were fully aware of being over committed. For example: “I’ve been asked to teach certain skills workshops and I get bogged down. Maybe it’s my fault because I don’t say ‘no’. You want to impress and to be seen as good in a new job, so you daren’t say ‘no’. My contract is so short and I therefore take on as much as I can.” (Lecturer practitioner) They expressed a need to prove themselves and expected this to involve working under excessive pressure. The literature surrounding the role had identified the need for good timemanagement skills and the ability to prioritise demands as being essential (Rigby et al. 1998), without them the lecturer practitioner would face enormous pressure trying to meet the requirements of ‘two masters’. They were also working at home in their own time to fulfil the demands of both university and practice. One lecturer practitioner expressed this as: “I spend my time either thinking, I’m never going to have time to do everything, or there must be something I can do easier than this which isn’t as much hassle. I feel that in the near future one side will have to go because I can’t do both sides as effectively as I want to.” Reduced time in the practice area had resulted in the lecturer practitioners being unable to take on the same responsibilities, yet practitioners still had the same expectations. Fulfilling the expectations of both service and education sides of the equation had been problematic. Demands had led them to question their ability to continue as they
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perceived they were not being effective in either role. Many lecturer practitioner posts have failed because of the pull in opposite directions (Murray & Thomas 1998). Timemanagement skills had improved with experience and the length of time in post. Either time was managed more effectively in the clinical area or the lecturer practitioners refused to take on teaching commitments they could not fulfil.
Contractual issues The lecturer practitioners felt that there was little structured support during the development of their role in the university and this was perceived to be a negative factor. The induction programme was described as ‘inadequate’. All were allocated a named mentor but experienced difficulties in accessing them and consequently this had proved to be of little benefit. Implicit within the responses was that this does need to be addressed as a thorough induction to people and personnel in both environments would provide role identity for individuals coming into post. They identified a distinct lack of communication between education and practice regarding their responsibilities in the opposite area: “There is no insight into the role from practice and no consideration from the university as to what you do in practice.” They emphasised the need for joint personal development plans (PDP) and felt that this was the solution to enhancing communication between the university and practice. If perceptions of the role differ between managers in university and practice there is a huge potential for role conflict and confusion. A danger that is clearly recognised in the literature (Murray & Thomas 1998). Lecturer practitioners questioned their two job descriptions, and it was felt that this enhanced the divide between the posts leading to the role being seen as ‘two parts’ with ‘two masters’, i.e. “The job description should be for one person, not half and half. I am a whole person.” (Lecturer practitioner)
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As the lecturer practitioner role is a joint initiative between service and education this would avoid some of the above dangers as it would identify clear responsibilities in service and education for the role holder. A more defined role is required to facilitate future development (Lee 1993). There are many factors surrounding contractual issues which have been influential in the development of the lecturer practitioner role, however despite these difficulties participants still believed that the role is the way forward in nursing education: “It’s a brilliant idea but there needs to be a lot more discussion about the role and its development, problems we’re having now we need to reflect on so we can move on.” (Lecturer practitioner) Although this was a small study the results have identified many positive and negative factors that have influenced the development of the lecturer practitioner role.
Conclusion The literature surrounding the development of the role is vast in relation to the potential to close the gap between theory and practice and the findings from this study firmly support this (Thompson et al. 1998). Lecturer practitioner initiatives are an exciting educational strategy that can contribute to the bridging of the theory-practice gap in both academic and clinical environments as they have the potential to facilitate learning by working with students and mentors in practical and theoretical settings. It has been suggested that the uniqueness of nurse education is its ability to produce autonomous, knowledgeable and reflective health care professionals (Department of Health 1999). The role provides the opportunity to maximise students learning in both environments through reflection in and upon practice. The potential for the lecturer practitioner to contribute to the educational needs of practitioners is also a positive aspect of the development of the role. Post registration education is perceived to be of equal importance as the knowledge and skills
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they develop in the university are utilised and shared with the practice area (Jones 1996). There is a distinct lack of knowledge from both university and practice regarding the roles and responsibilities of the lecturer practitioner in the opposite setting. This is contributing to role conflict and increased stress (Woodrow 1994). This could be explained by the ‘newness’ of the role as few people have a total picture of what lecturer practitioners do in either setting. It is important for managers to work together as this will also ensure that everyone is aware of the heavy workload that each side can present. The diversity of the role requires strong support strategies from both organisations (Thompson et al. 1998). Despite the difficulties the participants in this study believe that the lecturer practitioner role is valuable and a way forward in nursing education for both pre and post registration students. Lecturer practitioner’s gained a wealth of experience and were able to continue to develop clinical skills in the practice area whilst learning new teaching and academic skills in the university. Considering the complexity of the role the issue of how to prepare individual lecturer practitioners for the role must be addressed to utilise them effectively in both areas (Rhead & Strange 1996). The lecturer practitioner role is an exciting innovation that can straddle the worlds of higher education and practice (Shepherd et al. 1999). As such it is a post worthy of investment, planning and preparation in order to fulfil the potential and maximise the benefits. The findings from this study suggest that if this is not achieved, then the potential of the role for uniting theory and practice within nursing education will be lost.
Limitations The research approach achieved the aims of the study. The small number of participants and absence of systematic sampling characteristic of qualitative research means a lack of generalisability becomes a limitation (Bryman 1988). This sample was drawn from only one university and as such findings reflect that location and may not have application to other universities. The goal of naturalistic inquiry is not for generalisation (Lincoln &
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Guba 1985) but rather to unveil the nature, essences, characteristics and meanings of phenomena as fully and completely as possible, and within particular contexts. The expectations for determining whether the findings are transferable rests with the potential user of the findings and not with the researcher (Lincoln & Guba 1985).
Recommendations for practice One of the original aims of this study was to formulate recommendations to inform the development of future lecturer practitioner roles as this requires structure and understanding. Although this project was small the findings will be a valuable contribution to the future development of the role in the university and in practice if the following recommendations are actioned. There needs to be a clear focus for each lecturer practitioner introduced into the university where the role, responsibilities and expectations are clearly identified in both areas. This will aid introduction and acceptance of the role by colleagues. Joint Personal Development Plans involving managers from university and practice should be undertaken, where a designated period of time for educational development for the lecturer practitioner is agreed. A full induction into the university is essential along with the promotion of the role and responsibilities of the lecturer practitioner in raising awareness of the role. Lecturer practitioners should be practising clinicians delivering theoretical and clinical skills development around their area of expertise. A collaborative working group comprising of academic and clinical representatives including lecturer practitioners should be established to encourage networking and to ensure monitoring and evaluation of the role. References Aston L, Mallik M, Day C, Fraser 2000 An exploration into the role of the teacher/lecturer in practice: findings from a case study in adult nursing. Nurse Education Today 20:178–188 Benner P 1984 From novice to expert: excellence and power in clinical nursing. Addison-Wesley, USA Bryman A 1988 Quantity and quality in social research. Unwin Hyman, London
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