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Fulfillment in the role of academic nurse leader: A grounded theory study
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Journal of Professional Nursing journal homepage: www.elsevier.com/locate/jpnu
Fulfillment in the role of academic nurse leader: A grounded theory study☆ ⁎
Melissa Bouws , Alexa Madeira, Alaina Streberger Hope College, Holland, MI, United States of America
A B S T R A C T
Background: Unlike many other disciplines, academic nurse leaders are challenged with multiple expectations. The many vacancies in these positions indicate that further study on this phenomenon is needed to disclose aspects of their roles. Purpose: The purpose of this study is to describe the factors that influence academic nurse leaders' role attainment and fulfillment. Method: Analysis of 18 interviews with nurse deans, directors, and chairpersons was performed with grounded theory methodology. Results: Personality traits such as having a “skillset” and a “sense of calling” positively affected the nurse leader's role attainment and fulfillment. Other outside factors that affected role fulfillment were “experiencing a variety of relationships”, “seeing positive change”, “enjoying creative freedom”, “experiencing professional growth” and “having support from administration”. Some negative themes that resulted in a lack of fulfillment were “feeling overwhelmed with the number of hours and duties”, “being coerced into the role”, the “faculty shortage” and a “lack of mentorship”. Conclusion: By disclosing aspects of fulfillment and the academic nurse leader role, recruitment and retention within academic leadership will be affected.
Introduction Academic nurse leaders hold a unique position that influences current nursing practice, as well as the advancement of the profession. Few others have the potential to bring about change within the academic setting or hold such a strong influence on the future of nursing and on our students. Despite their high visibility and highly influential roles, very little is known about these leaders of our nursing programs, surprisingly. The role of academic nurse leader is far different from the responsibilities of deans, chairpersons and directors in other disciplines. There are unique challenges to the nursing profession which ensure that, when compared to other professions, it is much more difficult to adjust to. These challenges include being a leader in a female dominated profession, navigating a national nursing shortage, lack of funding for nursing research, and the demand for innovative curriculum based on standards for accreditation (Bouws, 2018). Review of the literature Past studies have revealed aspects of the role, what this administrative position entails, and how it differs from other leadership positions in various disciplines (Bouws, 2018; Bouws, Candela, & Bonnema, 2016). Research conducted on the role in the late 1990s indicated that few nurse leaders in academia had leadership or administrative experience outside the academy prior to taking the role (Wolverton &
Gmelch, 2002). The most common trajectory is that of leaders who begin as faculty and progress to department chair or faculty governance roles. Then they realize that it is not just an extension of a faculty role, but rather a complex and challenging position. These individuals quickly discover how great the preparation and obligations are, how unforgiving the schedule, and how varied the activities (Green & Ridenour, 2004). Nursing in the academic world is at the crossroads between higher education and health. Both sectors are male dominated and highly conservative and neither see nursing as a full contributor regarding most public policy regulation and direction (Dowling & Devereaux Melillo, 2015; Redman, 2001). Universities are also patriarchal and have made little effort to challenge the cultural norm of gender relationships (Kenner & Pressler, 2006; Kenner & Pressler, 2009; Redman, 2001; Ross, Marks-Maran, & Tye, 2013). One example of this difference is in a qualitative analysis on the journeys of ten nursing deans. The deans shared the importance of the title of dean, and the influence that has in comparison with chairperson and director. Other themes that emerged from the study were the importance of being heard at institutional leadership councils and legitimizing the position of dean. The participants described the “challenge of explaining the uniqueness of a nursing program to college administrators” (Dowling & Devereaux Melillo, 2015, p. 471) and how different the role of nurse dean is compared to other college dean roles. The importance of support both internally and externally with alumni and community stakeholders is essential for a successful execution of this
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This work was supported by the Nyenhuis Professional Development Funds, Hope College. Corresponding author. E-mail address: [email protected] (M. Bouws).
https://doi.org/10.1016/j.profnurs.2020.03.007 Received 1 October 2019; Received in revised form 9 March 2020; Accepted 17 March 2020 8755-7223/ © 2020 Elsevier Inc. All rights reserved.
Please cite this article as: Melissa Bouws, Alexa Madeira and Alaina Streberger, Journal of Professional Nursing, https://doi.org/10.1016/j.profnurs.2020.03.007
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your role as a nurse leader in the academic environment? b.) Can you take me back to other nursing roles you have held, and how this role differs from that time in your professional career? c.) Could you describe an experience you've had that held a significant meaning for you in this role? The interviews were transcribed by the principal investigator, along with the research team of undergraduate nursing students. The research team completed an audit trail of each member's thoughts and reflections of the interviews. Dependability was achieved through a process of the audit trail. To achieve dependability, inquiries were made to ensure the research process was logical, traceable and clearly documented. Peer debriefing was utilized as a method of rigor in the qualitative research process. This debriefing involved the assembling of peers, inclusive of undergraduate nursing research students and the principal investigator, to analyze various aspects of the inquiry and check for any bias on the part of the researcher—particularly if there was sufficient reflexivity, whether or not the data adequately portrays the phenomenon and if there are errors with interpretation (Marshall & Rossman, 1989). Authenticity is a criterion in Lincoln and Guba's (1985) framework to ensure trustworthiness. It refers to the extent in which the researchers demonstrate the realities of the participants, including feelings, emotions, full experiences and context, so that the reader may have a heightened sensibility toward the issues being portrayed. To ensure authenticity, verbatim excerpts from the participants' stories are included in the research results that illustrated key concepts and themes. The number of participants in this study was adequate when information saturation was achieved, which occurred when additional sampling provided only the redundancy of previously collected data, rather than new information (Burns, 1989). Grounded theory methods dictate coding and analysis of the data as it is collected. The researcher does not wait until data are completely collected to begin data analysis. Instead, data collection and analysis occur simultaneously (Corbin & Strauss, 1990). Essential themes were gleaned out of the interview texts by initial coding, focused coding and axial coding. Initial coding was done by a line-by-line sequencing of significant statements in participants' transcripts. Line-by-line initial coding reduced the likelihood of superimposing preconceived notions in data analysis. Focused coding was done by assessing the initial codes for meaning and significance. Statements or phrases that seemed to reveal aspects of the lived experience were highlighted and written on an index card. All data written on the index cards were spread out for examination and then organized into meaningful rows. Each row, which Marshall and Rossman (1989) describe as “buckets or baskets” (p. 154) into which segments of text are placed, depending on their subject matter, had similar topics. Every index card that contained significant statements was grouped together by the theme row and given a descriptive label. The index cards were then categorized in a small file box, according to their respective descriptive labels. Axial coding related categories to subcategories, which developed major themes by using audit trails, memo writing and reflexivity on emerging themes (Charmaz, 2014). Axial coding involved analyzing the significant statements and descriptive labels using Dedoose qualitative software for overarching themes. All the index cards were imported into the software. Utilizing qualitative software enabled the researchers to consider the frequency of significant statements as themes emerged. A research team, inclusive of undergraduate research students and the principal investigator, then reviewed the significant statements and descriptive labels and compared them to the content of the interviews for accuracy.
leadership role (Dowling & Devereaux Melillo, 2015). The ways in which these leaders experience this role, and whether they find fulfillment in this challenging position, is unknown. The risk of experiencing role ambiguity and role stress due to these challenges, along with the lack of preparation, is real though (Blass, 2011; Broome, 2013; Wolverton & Gmelch, 2002). Therefore, the characteristics of the academic leader's personal journey are important to understand in order to appreciate what may be required to successfully transition future leaders and retain them in their roles. Grounded theory designs are an inductive method of systematic sampling, data collection, and analysis. This method was chosen for this study due to the lack of nursing research on the vocational journey of the academic nurse leader. There are various publications on this role from former deans, as they personally give advice to others in the role or considering the role (Giddens & Morton, 2018; Mundt, 2017), but there is a significant gap in nursing research on this topic. Why do they step into the role in the first place? What leads these leaders to grow and be fulfilled in this role? An investigation of the process of being fulfilled in this role is needed to recruit and retain nurse academic leaders who will further the profession by educating nursing students. Method Grounded theory methodology combines the researchers' interaction and involvement with the participants in constructing a theory (Charmaz, 2014). The researcher's interaction involved a constant comparative analysis and theoretical sampling in order to have the theory emerge from the data (Strauss & Corbin, 1998). The overall research question for this grounded theory study was “How do academic nurse leaders adjust to their leadership role in order to feel fulfilled?” The Hope College Human Subjects Review Board (HSRB)—through the principal investigator's institution—approved the research proposal and informed consent. Upon approval from the HSRB, the data recruitment for the study commenced. Each participant was given the informed consent for review prior to the interview, as well as a consent to be recorded via digital voice recorder. Eighteen participants, who held the title of dean, director, or chairperson of a nursing program in the Midwest regions of Ohio, Indiana, Illinois and Michigan as well as Maine were included in the study. The participants were identified by information gathered through snowball sampling and internet searches for the convenience sampling, purposeful sampling, and theoretical sampling. Recruitment was initiated through email. Convenience sampling was used to obtain the scope and dimensions of the problem, as five participants were initially interviewed as a convenience sample due to proximity of location for a face-to-face interview. These five participants were women who have had the role of dean or director for less than five years. Another eight participants were then included in the study, based on purposeful sampling, which targeted people whose characteristics met the needs of the emerging data (Strauss & Corbin, 1998). During the sampling process, it was evident that interviews with more chairpersons of nursing programs, as well as male leaders, were needed. Furthermore, academic nurse leaders who had more experience in the role were required as well. Based on theoretical sampling procedures, five more participants were recruited in order to explore the multiple dimensions of the social process of these leaders' journey with fulfillment in the role (Starks & Trinidad, 2007). Demographics on the participants are described in Tables 1–5 inclusive of Carnegie classification and type of school (Table 1), number of students at the institution (Table 2), gender (Table 3), title (Table 4), and number of years in the role (Table 5). Data were collected with face-to-face and phone interviews which were audio-recorded. An interview guide was used that featured three overarching questions. To complete the unstructured interview, the following questions were used for the guide: a.) Can you tell me about
Results Personality traits: trunk of the tree Having a skillset The participants expressed a skillset they possessed that enabled a 2
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Table 1 Type of school and Carnegie classification.
same skillset[s] as an academic leader. So, the things that make one a brilliant researcher are not the same skills that make one a good dean.”
smoother transition to the role of academic nurse leader. Some attributes that these nurse leaders naturally process are leading change, organization intellect, professional values and interpersonal skills and self-awareness (Giddens & Morton, 2018). Examples of these skills that emerged from the data are experience in leadership positions, previous knowledge related to management and budgets, and experience with connecting with stakeholders. There were 113 significant statements for this theme (Table 6 Number of Significant Statements). The following quotes from Participant 4 are some verbatim accounts of this theme of having a skillset: “…and I guess for me the notion that it's kind of rooted in you and, as I explored opportunities in academic leadership, it was clearly where I was home.” and “It's not a fit for everyone. And I would suggest that the skills required to be a traditional academic are not the
A sense of calling There is also a spiritual component to the vocation of academic nurse leader. Many interviewees expressed a “call” to serve their departments and/or colleges, as well as an alignment with the mission and vision in which they worked, regardless of the institution's religious affiliation. There is a fundamental responsibility for the academic nurse leader to lead the college or department of nursing in development or reaffirmation of the mission and vision of the college or university. This involves creating strategic plans that aligns with the leaders' own personal vision (Mundt, 2017). Participant 5 stated, “I have an ability to
Table 2 Number of students in the school.
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Table 3 Gender of participants.
focused”, “I can work from a meeting with a student who is having difficulty progressing, to a meeting with a donor who is thinking about a major gift, to leading a national project for my professional association” and “For me, there's never a dull moment. I think that the ability to move multiple projects forward at the same time is satisfying to me.”
draw others to my vision.” Participant 10 said, “I think an important piece of this role is to be able to shape and influence and to build a team who can share a cohesive vision and then work to enact that vision.” Some other examples of having a sense of calling to the role are: “I wanted to draw others [to] the [school's] vision” (Participant 6), “I was able to live out the mission” (Participant 10), “It was never in the plan; I was just listening to God and I was willing to answer” and “So there is a lot of spiritual pieces, like trusting what my path is [and] trusting that Christ will see me through” was shared by Participant 7. There were 98 significant statements for this theme (Table 6).
Seeing positive change The participants also voiced that they saw their role as an exciting opportunity for change. The following quotes depict how the academic nurse leaders perceive the role not only as a chance to see positive change, but to also be innovative.
Extrinsic factors of fulfillment: leaves of the tree These themes were categorized as outside the person themselves. The participants found fulfillment in a variety of tasks and interactions with others in the role.
“I like being in a position to help make decisions, policy changes. I like that” (Participant 5) and “It's…I mean.… some aspects of this job are really fun. I like being in a position where I can effect change. I like to see people getting into the sort of situation where they have some excitement about what they want to do and letting them go do it and see what happens”. (Participant 11)
Experiencing a variety of relationships The joy having a variety of varied relationships with other professionals was expressed by multiple participants through many significant statements (Table 6). These relationships included their interactions with nursing faculty, leaders in other disciplines, professionals in the clinical settings, and nursing students. As an example, the following quotes were provided by Participants 4 and 10:
Enjoying creative freedom These nurse leaders also enjoyed the opportunity to have creative freedom, as represented in the following quotations: “My lens has changed; people would say you are just so different, your mind is so different. You think differently, you see things differently, you're so
“…when I think about the variety of things I'm able to do every day—so many of them internally focused, many of them externally
Table 4 Title of participants.
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Table 5 Number of years in the role.
leadership”. Participant 13 stated “I really like this role. I like the variety, so it gives me an opportunity to interact with students [and] faculty across campus and have brainstorming sessions where we can think about how we can do things better”, “I am able to participate in discussions that are more university focused”, “I'm expected to look more for what's in the best interest and the greater good of the university at large”,
Table 6 Number of significant statements. Theme
Number of significant statements
Having a skillset Having a sense of calling Experiencing a variety of relationships Seeing positive change Enjoying creative freedom Enjoying professional growth Having support from administration Feeling overwhelmed with the number of hours/ duties Being coerced into the role Faculty shortage Lacking mentorship
113 98 236 91 28 72 43 232
“I feel a sense of ownership in faculty governance and being an active participant in the structure of the school” and “I get to talk with leaders in the community…it's out of my comfort zone so it's been a really good growth process for me”. (Participant 10)
75 72 59
Having support from the administration Support from the administration of the academic institution was also valuable to the nurse leaders' fulfillment in their roles. The following quotes demonstrate this aspect: “I have a boss who I have been able to, during the difficult times, kind of pull back and reflect with him…about even my own actions. I've been able to have conversations…and continue to learn from this person, which I certainly think impacts me” (Participant 13), Participant 7 stated “My boss was phenomenal”, “The role has been very supported” (Participant 15) and “I've felt tremendous support” was stated by Participant 18.
much more global in your perspective and I'm very proud of that” (Participant 3) and Participant 8 stated: “I can't sit in my office and create a chapter or lecture. I have to be in my happy place, which is usually my couch on a weekend or [in the] evening. There are places you can be creative, and times you can be creative. The role is much more than just meetings; it is developing a curriculum. I work when I feel the creativity coming from me, which is usually nights and weekends. It has to be during [a] time when you feel creative, you know?”
Negative factors that inhibited fulfillment: clouds
These quotes emulate that excitement of being a voice at the table, as well as a part of something outside of the department or college of nursing.
These themes are included because they are a part of the participants' personal journey in the role. Unfortunately, the participants expressed that these factors can impede their fulfillment.
Enjoying professional growth The academic nurse leaders also expressed an opportunity for the role to bring professional growth, which had a positive influence on their leadership skills. They described the joy of interacting others outside of the nursing college or department on a professional level and having a drive for a leadership position. They saw themselves as being part of decision making at the university level and representing nursing with other disciplines. There were 72 statements (Table 6) that led to this theme of enjoying professional growth, such as: “…This is kind of the role I always aspired to” (Participant 4), “I knew I wanted to be in a leadership role and so I felt good. I like it” (Participant 10), “I don't think you'd last terribly long in a role like this if you didn't love it because of the intense pressures in terms of time and time commitment…It is satisfying to me though” and “I initially got interested in administration …so it was a chance for me to really learn a lot about
Feeling overwhelmed with the number of hours and duties As described in the Review of the literature, academic nurse leaders have aspects of their position that are unique to nursing and bring additional stressors (Bouws et al., 2016). Some examples are lacking funding to support their research or their faculty's research agendas, the nursing faculty shortage, and the need for innovative curriculum. The nursing profession is now at the point in which the advancement of nursing knowledge, through scientific research, is disadvantaged by the tradition of grant monies being awarded to highimpact sciences, such as medicine, public health and pharmacy. Compared to other health disciplines, schools of nursing are among the lowest funded for research (National Institute of Health, Research Portfolio Online Reporting Tools, 2018), which continues to hinder the research productivity of the nursing profession. The amount of funding 5
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work and not enough time. I feel like I could just sit in my office and work from 7:00 AM to 7:00 PM, and maybe midnight even, seven days a week and I'd probably never get to do everything I want to do. I think it's the nature of being in an administrative position. I think people in other departments, other disciplines, would possibly say the same thing. With nursing, I think because we have external accreditation standards, we've got university requirements, we've got external constituencies, we've got over 800 clinical affiliation agreements. I have a lot of staff that help me, but it's just a big operation, so I don't know.”
depends on research productivity, and the nursing profession's relatively low level of funded research positions its capacity to influence practice and policy, based on scientific evidence, at a disadvantage. To ensure nursing competes effectively with other health-related disciplines, nursing leaders must find ways to help a greater proportion of nursing faculty excel as scientists and produce enough volume and quality of work. Many nursing leaders in academia expressed the frustration that they cannot complete their research agendas or do not have the means to support their faculty in that way. Participant 5 stated “Because I graduated with a PhD and have only had a couple of publications, I really need more. So that's been, that kind of upsets me because you need time and money to do that as well.”
Lack of mentorship Academic nurse leadership often comes into their role with little to no mentorship. These nurse leaders often seek out their own mentors and find they are lonely in the role due to the uniqueness of the nursing academic leaders' duties. This theme was evident even with the male participants of the study, as they had their own unique challenges in this role regarding mentorship. Participant 15 stated “I struggled with the male part of this role. People were not necessarily kind about it…it was other colleagues, other nurses.” Some other examples are: “You are a nurse and you are a man and how could you possibly perform this role?” “It is still something nursing has to work on. Nursing faculty have to work on stopping making men feel bad for wanting to be a nurse.” “Gender does play an effect because I approach things a lot differently than my female colleagues.” Participant 14 stated he felt “unprepared for this job”. “Nothing prepares you for this leadership position.” Participant 9 felt the same. They stated “I can tell you from my experience that we do not mentor new deans. We do not. We just eat each other up.” “They don't let you in ‘the group’ unless you are CCNE accredited.”
“I was jealous of other people. I'm watching them get grants or moving forward or getting any kind of scholarship. I just wasn't. I couldn't. It is all a juggle. Nursing all is a juggle anyway, and I just didn't have that scholarship ball that I could keep in the air there and I was jealous of other people getting published”. (Participant 16) There is a new vision to transform the education of nurses, so that they are relevant to the current advancement of science, technology, patient activism, the market-driven health care environment and the nature and settings of nursing practice (Benner, Sutphen, Leonard, & Day, 2010). To maintain this vision, the transformation of curriculum needs to employ innovative approaches to nursing education, rather than the current practice that is saturated in content (Giddens et al., 2008). The interprofessional education of nursing students is a current curriculum requirement that fosters a collaborative approach to patient care. Therefore, collaborative practice and interprofessional education is now an expected component of the curriculum of both medical and nursing schools. Nursing academic leaders are enhancing this concept throughout nursing courses in order to remain up to date, concerning professional practice (Makino et al., 2015). Clearly, this requires thoughtful time for leaders of nursing programs to not only consider curriculum transformation, but the influence it has on nursing faculties' workload assignments as well. Curriculum drivers, such as the Quality and Safety Education for Nurses (QSEN), the Essentials of Baccalaureate Education for Professional Nursing Practice (BSN Essentials) established by the American Association of Colleges of Nursing (AACN), the National Council for Licensure Examination for Registered Nurses (NCLEX) test plan and the upcoming changes in the BSN competency-based education are compelling schools of nursing to update their curriculum to comply with current standards in nursing practice. As a result, the nursing leaders faces the challenge of motivating and leading in a culture of change for nursing faculty—by creating educational environments (that foster professional attentiveness, responsibility and excellence) where students learn and have salient nursing practice (Benner et al., 2010). An example of this impact to that emulates the stress of mentoring faculty in this way is the following excerpt by Participant 17:
Being coerced in the role The participants expressed the emergence of this role in their professional careers as unexpected, being coerced or being “thrust into leadership” (Pearsall, Stiles & Horton-Deutch as cited in Berman, 2015 p. 298). These academic nurse leaders identified themselves in the role only after being recruited into leadership positions by others (Berman, 2015; Bouws et al., 2016). Participant 11 stated “my administrator heard of a position as director of nursing. She sent that information to me and it was not ‘you should apply’ it was more ‘I want you to apply’”. Participant 13 stated “Landing is exactly what happened. Landing is a good word because honestly, I didn't have the time for this role at all. That isn't something that I even have my sights on doing.” Faculty shortage Academic nurse leaders face the challenge of recruiting new nursing faculty, as the majority are nearing retirement. Nursing programs are turning away qualified applicants due to insufficient funds to hire new faculty and the unwillingness of administrations to commit to additional full-time positions. Another critical barrier to the faculty shortage is noncompetitive salaries. These leaders must recruit new nursing faculty while hospitals are dramatically increasing salaries for nurses (Bouws, 2018). In fact, according to an AACN report, from 2018 to 2019, 872 nursing schools reported full-time vacancies when they responded to a faculty vacancy survey (Rosseter, 2019). United States nursing schools have also turned away 75,029 qualified applicants from baccalaureate and graduate nursing programs because of an insufficient number of nursing faculty, classroom space or clinical sites, clinical preceptors and budget constraints. The majority of nursing programs admitted that insufficient funds to hire new faculty, along with the unwillingness of administration to commit to additional full-time positions were the main reasons they turned away qualified applicants (Rosseter, 2019). Additionally, nursing school deans face the daunting challenge of recruiting new nursing faculty, just as competition for the limited supply of nurses has forced hospitals to dramatically increase
“A lot of faculty that have master's degrees may be good in the clinical aspect, but they do not have a background in education. They have a background in clinical, so they come to me in that regard, not having any curriculum work, coming to me needing mentoring. They do not understand the power of active learning styles and strategies. They are talking heads, not a guide on the side.” The overall number of hours can be daunting as well as the variety of tasks the academic nurse leader is responsible for. Participant 11 stated: “I've been a chair, I've been a director, I've been a dean, no matter what the nurse role is, it just seems like there's always too much 6
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Recommendations for nursing education
salaries. Many graduates of nursing PhD programs are in their 30s and 40s and have mortgages, children and student loans, so the salary of a position is an important factor as they decide whether or not they will pursue a career in academia. The most critical barriers that schools reported, as they hired new nursing faculty, are noncompetitive salaries. In particular, they have difficulty hiring DNP/FNP nurses into faculty roles, due to high practitioner salaries (AACN, 2019). Participant 12 stated “they have been wanting me to increase our numbers and enroll more students. Well, I don't have all my courses covered for the fall as it is.” and from Participant 1:
Presently, the nursing profession is facing an employment crisis, as there is not only a shortage of nurses at the bedside, but a lack of nursing faculty and academic leaders as well. As this research study revealed, to ensure academic leaders feel fulfilled in their roles (regardless of their experience levels), the importance of retention and recruitment—as well as the ways in which they can enjoy smoother career transitions, particularly through the fostering of relationships—should not be overlooked. The importance of fostering relationships, guidance, support, and openness to change is pivotal to these academic leaders who are willing to step into the position. Many of these leaders seek to help of others in their state or through the AACN mentorship programs but found support from their faculty and upper administration is also important. Additional study on this phenomenon is warranted. Academic nurse leaders are a group of individuals who are part of an important social process that affects the retention and recruitment of other leaders in the nursing profession. As the United States faces a massive nursing faculty shortage (Rosseter, 2019), there is a need to address the leadership in schools of nursing across the country. It is critical—to the future of nursing—that enough aspiring leaders can successfully make this transition. In conclusion, similar research should continue in order to explore new methods of smoother career transitions, as well as the aspects of this role fulfillment, so that future nursing professionals will continue to accept academic leadership positions.
“it's really hard to get doctorally prepared nurses. We have more and more adjunct, it is really hard to get full time but then we are not going to have the richness we are not going to have the background of the other disciplines at the doctoral level that are going to expand the nursing science, I think there are going to be less nursing faculty that are research oriented.”
Discussion The theory that emerged from the data involves a social process of role fulfillment. The participants found that reaching out to others for assistance in adapting to their role as academic nurse leader, as well as having support from upper administration, collaborating with other professionals and mentoring others were pivotal for role fulfillment. Seven themes emerged as fulfilling to the academic nurse leader and four themes described aspects of the role that negatively impacted fulfillment. Fig. 1 depicts the theory as a tree. The trunk of the tree is inclusive of two themes which are intrinsic, within the academic nurse leaders' personality traits. Data revealed that having a skill set along with a sense of calling, are part of nurse leaders' dispositions. These factors were part of who they were as an academic nurse leader. The five leaves of the tree are extrinsic factors that enable fulfillment in the role which are outside of the participants' personality traits. The four clouds demonstrate themes that negatively impact fulfillment in the role.
Limitations Findings from this study were limited by the lack of gender diversity, as most of the participants were female. Yet, triangulation and maximum variation sampling would likely have been enhanced (Patton, 1990) if male nursing administrators had participated in this study. Furthermore, the geographical locations of the interviews were focused in one area of the. United States. This lack of diverse locale may be a limitation as well, as the process of interview, analysis and data organization, into themes
Fig. 1. The theory of role fulfillment in academic nurse leaders. 7
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and subthemes, was based on the findings of limited geographical regions.
https://doi.org/10.5430/jnep.v6n8p43. Broome, M. E. (2013). Self-reported leadership styles of deans of baccalaureate and higher degree nursing programs in the United States. Journal of Professional Nursing, 29, 323–329. https://doi.org/10.1016/j.profnurs.2013.09.001. Burns, N. (1989). Standards for qualitative research. Nursing Science Quarterly, 2(1), 44–52. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London, UK: Sage. Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13, 3–21. Dowling, J. S., & Devereaux Melillo, K. (2015). Transitioning from departments to schools of nursing: A qualitative analysis of journeys by ten deans. Journal of Professional Nursing, 31, 464–474. https://doi.org/10.1016/j.profnurs.2015.04.008. Giddens, J., Brady, D., Brown, P., Wright, M., Smith, D., & Harris, J. (2008). A new curriculum for a new era of nursing education. Nursing Education Perspectives, 29, 200–203. Giddens, J., & Morton, P. (2018). Pearls of wisdom for chief academic nursing leaders. Journal of Professional Nursing, 34, 75–81. https://doi.org/10.1016/j.profnurs.2017. 10.002. Green, A, & Ridenour, N (2004). Shaping a career trajectory in academic administration leadership development for the deanship. Journal of Nursing Education, 42, 489–494. Kenner, C., & Pressler, J. (2006). Successfully climbing the academic leadership ladder. Nurse Educator, 31, 1–3. https://doi.org/10.1097/00006223-200601000-00001. Kenner, C., & Pressler, J. (2009). Barriers to carrying out the dean role. Nurse Educator, 34, 1–2. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. Makino, T., Nozaki, S., Bumsuk, L., Matsui, H., Yoshiharu, T., Shinozaki, H., & Watanabe, H. (2015). Attitudes of nursing school deans toward interprofessional education in Western Pacific Region countries. Journal of Interprofessional Care, 29, 518–519. https://doi.org/10.3109/13561820.2015.1027337. Marshall, C., & Rossman, G. (1989). Designing qualitative research. Newbury Park, CA: Sage. Mundt, M. (2017). Reflections on a dean’s career: Lessons learned. Journal of Professional Nursing, (34), 142–146. https://doi.org/10.1016/j.profnurse.2017.07.012. National Institutes of Health, Research Portfolio Online Reporting Tools (2018). Nurse scientists as participants in the NIH-funded workforce. Retrieved from https://report. nih.gov/Workforce/PSW/nurse_scientist_participants.aspx. Patton, M. (1990). Qualitative research and evaluation methods. Newbury Park, CA: Sage. Redman, B. (2001). The dean of nursing as arbiter, antagonist, and advocate. Nursing Administration Quarterly, 25, 57–63. Ross, F., Marks-Maran, D., & Tye, C. (2013). A foot in two camps: An exploratory study of nurse leaders in universities. Nurse Education Today, 33, 1342–1346. https://doi.org/ 10.1015/j.nedt.2013.02.008. Rosseter, R. (2019). Fact sheet: Nursing faculty shortage. Retrieved from American Association of Colleges of Nursinghttps://www.aacnnursing.org/Portals/42/News/ Factsheets/Faculty-Shortage-Factsheet.pdf. Starks, H., & Trinidad, S. B. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17(10), 1372–1380. Strauss, A. L., & Corbin, J. (1998). Basics of qualitative research: Grounded theory procedures and techniques (2nd ed.). Newbury Park, CA: Sage Publications. Wolverton, M., & Gmelch, W. (2002). College deans: Leading from within. Westport, CT: American Council on Education/Oryx Press.
Recommendations for future research This study has contributed to the limited research on academic nurse leaders, aspects of fulfillment with their roles. The results of the data analysis indicated that these nurses in academia are leaders in the profession who have professional aspirations for their faculty and students, but have stressors that impact their role fulfillment. Although this study has revealed what those stressors entail, additional studies should be conducted to explore academic nurse leaders as they transition from novices to proficient and confident leaders that can serve as mentors to others. A more transitional, longitudinal study using a mixed method design could potentially result in a better understanding of the role, and the ways in which these leaders can implement more mentorship to facilitate smoother transition for future novice deans in later years. Declaration of competing interest None. Acknowledgements This work was supported by the Nyenhuis Professional Development Funds, Hope College, Holland, Michigan, USA. References American Association of Colleges of Nursing (AACN) (2019). DNP fact sheet. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Josey-Bass. Berman, A. (2015). Academic leadership development: A case study. Journal of Professional Nursing, (31), 298–304. https://doi.org/10.1016/j.profnurse.2015.02. 006. Blass, T. (2011). A nurse at heart: The journeys and experiences of nursing school deans (Doctoral dissertation). Available from. ProQuest Nursing & Allied Health Source (UMI No. 3472518). Bouws, M. (2018). The nursing dean role: An integrative review. Nursing Education Perspectives, 39, 80–84. https://doi.org/10.1097/01.NEP.0000000000000277. Bouws, M., Candela, L., & Bonnema, J. (2016). The novice nursing dean: A qualitative study of the lived experience. Journal of Nursing Education and Practice, 6, 43–51.
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Contents lists available at ScienceDirect
Journal of Professional Nursing journal homepage: www.elsevier.com/locate/jpnu
Fulfillment in the role of academic nurse leader: A grounded theory study☆ ⁎
Melissa Bouws , Alexa Madeira, Alaina Streberger Hope College, Holland, MI, United States of America
A B S T R A C T
Background: Unlike many other disciplines, academic nurse leaders are challenged with multiple expectations. The many vacancies in these positions indicate that further study on this phenomenon is needed to disclose aspects of their roles. Purpose: The purpose of this study is to describe the factors that influence academic nurse leaders' role attainment and fulfillment. Method: Analysis of 18 interviews with nurse deans, directors, and chairpersons was performed with grounded theory methodology. Results: Personality traits such as having a “skillset” and a “sense of calling” positively affected the nurse leader's role attainment and fulfillment. Other outside factors that affected role fulfillment were “experiencing a variety of relationships”, “seeing positive change”, “enjoying creative freedom”, “experiencing professional growth” and “having support from administration”. Some negative themes that resulted in a lack of fulfillment were “feeling overwhelmed with the number of hours and duties”, “being coerced into the role”, the “faculty shortage” and a “lack of mentorship”. Conclusion: By disclosing aspects of fulfillment and the academic nurse leader role, recruitment and retention within academic leadership will be affected.
Introduction Academic nurse leaders hold a unique position that influences current nursing practice, as well as the advancement of the profession. Few others have the potential to bring about change within the academic setting or hold such a strong influence on the future of nursing and on our students. Despite their high visibility and highly influential roles, very little is known about these leaders of our nursing programs, surprisingly. The role of academic nurse leader is far different from the responsibilities of deans, chairpersons and directors in other disciplines. There are unique challenges to the nursing profession which ensure that, when compared to other professions, it is much more difficult to adjust to. These challenges include being a leader in a female dominated profession, navigating a national nursing shortage, lack of funding for nursing research, and the demand for innovative curriculum based on standards for accreditation (Bouws, 2018). Review of the literature Past studies have revealed aspects of the role, what this administrative position entails, and how it differs from other leadership positions in various disciplines (Bouws, 2018; Bouws, Candela, & Bonnema, 2016). Research conducted on the role in the late 1990s indicated that few nurse leaders in academia had leadership or administrative experience outside the academy prior to taking the role (Wolverton &
Gmelch, 2002). The most common trajectory is that of leaders who begin as faculty and progress to department chair or faculty governance roles. Then they realize that it is not just an extension of a faculty role, but rather a complex and challenging position. These individuals quickly discover how great the preparation and obligations are, how unforgiving the schedule, and how varied the activities (Green & Ridenour, 2004). Nursing in the academic world is at the crossroads between higher education and health. Both sectors are male dominated and highly conservative and neither see nursing as a full contributor regarding most public policy regulation and direction (Dowling & Devereaux Melillo, 2015; Redman, 2001). Universities are also patriarchal and have made little effort to challenge the cultural norm of gender relationships (Kenner & Pressler, 2006; Kenner & Pressler, 2009; Redman, 2001; Ross, Marks-Maran, & Tye, 2013). One example of this difference is in a qualitative analysis on the journeys of ten nursing deans. The deans shared the importance of the title of dean, and the influence that has in comparison with chairperson and director. Other themes that emerged from the study were the importance of being heard at institutional leadership councils and legitimizing the position of dean. The participants described the “challenge of explaining the uniqueness of a nursing program to college administrators” (Dowling & Devereaux Melillo, 2015, p. 471) and how different the role of nurse dean is compared to other college dean roles. The importance of support both internally and externally with alumni and community stakeholders is essential for a successful execution of this
☆ ⁎
This work was supported by the Nyenhuis Professional Development Funds, Hope College. Corresponding author. E-mail address: [email protected] (M. Bouws).
https://doi.org/10.1016/j.profnurs.2020.03.007 Received 1 October 2019; Received in revised form 9 March 2020; Accepted 17 March 2020 8755-7223/ © 2020 Elsevier Inc. All rights reserved.
Please cite this article as: Melissa Bouws, Alexa Madeira and Alaina Streberger, Journal of Professional Nursing, https://doi.org/10.1016/j.profnurs.2020.03.007
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your role as a nurse leader in the academic environment? b.) Can you take me back to other nursing roles you have held, and how this role differs from that time in your professional career? c.) Could you describe an experience you've had that held a significant meaning for you in this role? The interviews were transcribed by the principal investigator, along with the research team of undergraduate nursing students. The research team completed an audit trail of each member's thoughts and reflections of the interviews. Dependability was achieved through a process of the audit trail. To achieve dependability, inquiries were made to ensure the research process was logical, traceable and clearly documented. Peer debriefing was utilized as a method of rigor in the qualitative research process. This debriefing involved the assembling of peers, inclusive of undergraduate nursing research students and the principal investigator, to analyze various aspects of the inquiry and check for any bias on the part of the researcher—particularly if there was sufficient reflexivity, whether or not the data adequately portrays the phenomenon and if there are errors with interpretation (Marshall & Rossman, 1989). Authenticity is a criterion in Lincoln and Guba's (1985) framework to ensure trustworthiness. It refers to the extent in which the researchers demonstrate the realities of the participants, including feelings, emotions, full experiences and context, so that the reader may have a heightened sensibility toward the issues being portrayed. To ensure authenticity, verbatim excerpts from the participants' stories are included in the research results that illustrated key concepts and themes. The number of participants in this study was adequate when information saturation was achieved, which occurred when additional sampling provided only the redundancy of previously collected data, rather than new information (Burns, 1989). Grounded theory methods dictate coding and analysis of the data as it is collected. The researcher does not wait until data are completely collected to begin data analysis. Instead, data collection and analysis occur simultaneously (Corbin & Strauss, 1990). Essential themes were gleaned out of the interview texts by initial coding, focused coding and axial coding. Initial coding was done by a line-by-line sequencing of significant statements in participants' transcripts. Line-by-line initial coding reduced the likelihood of superimposing preconceived notions in data analysis. Focused coding was done by assessing the initial codes for meaning and significance. Statements or phrases that seemed to reveal aspects of the lived experience were highlighted and written on an index card. All data written on the index cards were spread out for examination and then organized into meaningful rows. Each row, which Marshall and Rossman (1989) describe as “buckets or baskets” (p. 154) into which segments of text are placed, depending on their subject matter, had similar topics. Every index card that contained significant statements was grouped together by the theme row and given a descriptive label. The index cards were then categorized in a small file box, according to their respective descriptive labels. Axial coding related categories to subcategories, which developed major themes by using audit trails, memo writing and reflexivity on emerging themes (Charmaz, 2014). Axial coding involved analyzing the significant statements and descriptive labels using Dedoose qualitative software for overarching themes. All the index cards were imported into the software. Utilizing qualitative software enabled the researchers to consider the frequency of significant statements as themes emerged. A research team, inclusive of undergraduate research students and the principal investigator, then reviewed the significant statements and descriptive labels and compared them to the content of the interviews for accuracy.
leadership role (Dowling & Devereaux Melillo, 2015). The ways in which these leaders experience this role, and whether they find fulfillment in this challenging position, is unknown. The risk of experiencing role ambiguity and role stress due to these challenges, along with the lack of preparation, is real though (Blass, 2011; Broome, 2013; Wolverton & Gmelch, 2002). Therefore, the characteristics of the academic leader's personal journey are important to understand in order to appreciate what may be required to successfully transition future leaders and retain them in their roles. Grounded theory designs are an inductive method of systematic sampling, data collection, and analysis. This method was chosen for this study due to the lack of nursing research on the vocational journey of the academic nurse leader. There are various publications on this role from former deans, as they personally give advice to others in the role or considering the role (Giddens & Morton, 2018; Mundt, 2017), but there is a significant gap in nursing research on this topic. Why do they step into the role in the first place? What leads these leaders to grow and be fulfilled in this role? An investigation of the process of being fulfilled in this role is needed to recruit and retain nurse academic leaders who will further the profession by educating nursing students. Method Grounded theory methodology combines the researchers' interaction and involvement with the participants in constructing a theory (Charmaz, 2014). The researcher's interaction involved a constant comparative analysis and theoretical sampling in order to have the theory emerge from the data (Strauss & Corbin, 1998). The overall research question for this grounded theory study was “How do academic nurse leaders adjust to their leadership role in order to feel fulfilled?” The Hope College Human Subjects Review Board (HSRB)—through the principal investigator's institution—approved the research proposal and informed consent. Upon approval from the HSRB, the data recruitment for the study commenced. Each participant was given the informed consent for review prior to the interview, as well as a consent to be recorded via digital voice recorder. Eighteen participants, who held the title of dean, director, or chairperson of a nursing program in the Midwest regions of Ohio, Indiana, Illinois and Michigan as well as Maine were included in the study. The participants were identified by information gathered through snowball sampling and internet searches for the convenience sampling, purposeful sampling, and theoretical sampling. Recruitment was initiated through email. Convenience sampling was used to obtain the scope and dimensions of the problem, as five participants were initially interviewed as a convenience sample due to proximity of location for a face-to-face interview. These five participants were women who have had the role of dean or director for less than five years. Another eight participants were then included in the study, based on purposeful sampling, which targeted people whose characteristics met the needs of the emerging data (Strauss & Corbin, 1998). During the sampling process, it was evident that interviews with more chairpersons of nursing programs, as well as male leaders, were needed. Furthermore, academic nurse leaders who had more experience in the role were required as well. Based on theoretical sampling procedures, five more participants were recruited in order to explore the multiple dimensions of the social process of these leaders' journey with fulfillment in the role (Starks & Trinidad, 2007). Demographics on the participants are described in Tables 1–5 inclusive of Carnegie classification and type of school (Table 1), number of students at the institution (Table 2), gender (Table 3), title (Table 4), and number of years in the role (Table 5). Data were collected with face-to-face and phone interviews which were audio-recorded. An interview guide was used that featured three overarching questions. To complete the unstructured interview, the following questions were used for the guide: a.) Can you tell me about
Results Personality traits: trunk of the tree Having a skillset The participants expressed a skillset they possessed that enabled a 2
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Table 1 Type of school and Carnegie classification.
same skillset[s] as an academic leader. So, the things that make one a brilliant researcher are not the same skills that make one a good dean.”
smoother transition to the role of academic nurse leader. Some attributes that these nurse leaders naturally process are leading change, organization intellect, professional values and interpersonal skills and self-awareness (Giddens & Morton, 2018). Examples of these skills that emerged from the data are experience in leadership positions, previous knowledge related to management and budgets, and experience with connecting with stakeholders. There were 113 significant statements for this theme (Table 6 Number of Significant Statements). The following quotes from Participant 4 are some verbatim accounts of this theme of having a skillset: “…and I guess for me the notion that it's kind of rooted in you and, as I explored opportunities in academic leadership, it was clearly where I was home.” and “It's not a fit for everyone. And I would suggest that the skills required to be a traditional academic are not the
A sense of calling There is also a spiritual component to the vocation of academic nurse leader. Many interviewees expressed a “call” to serve their departments and/or colleges, as well as an alignment with the mission and vision in which they worked, regardless of the institution's religious affiliation. There is a fundamental responsibility for the academic nurse leader to lead the college or department of nursing in development or reaffirmation of the mission and vision of the college or university. This involves creating strategic plans that aligns with the leaders' own personal vision (Mundt, 2017). Participant 5 stated, “I have an ability to
Table 2 Number of students in the school.
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Table 3 Gender of participants.
focused”, “I can work from a meeting with a student who is having difficulty progressing, to a meeting with a donor who is thinking about a major gift, to leading a national project for my professional association” and “For me, there's never a dull moment. I think that the ability to move multiple projects forward at the same time is satisfying to me.”
draw others to my vision.” Participant 10 said, “I think an important piece of this role is to be able to shape and influence and to build a team who can share a cohesive vision and then work to enact that vision.” Some other examples of having a sense of calling to the role are: “I wanted to draw others [to] the [school's] vision” (Participant 6), “I was able to live out the mission” (Participant 10), “It was never in the plan; I was just listening to God and I was willing to answer” and “So there is a lot of spiritual pieces, like trusting what my path is [and] trusting that Christ will see me through” was shared by Participant 7. There were 98 significant statements for this theme (Table 6).
Seeing positive change The participants also voiced that they saw their role as an exciting opportunity for change. The following quotes depict how the academic nurse leaders perceive the role not only as a chance to see positive change, but to also be innovative.
Extrinsic factors of fulfillment: leaves of the tree These themes were categorized as outside the person themselves. The participants found fulfillment in a variety of tasks and interactions with others in the role.
“I like being in a position to help make decisions, policy changes. I like that” (Participant 5) and “It's…I mean.… some aspects of this job are really fun. I like being in a position where I can effect change. I like to see people getting into the sort of situation where they have some excitement about what they want to do and letting them go do it and see what happens”. (Participant 11)
Experiencing a variety of relationships The joy having a variety of varied relationships with other professionals was expressed by multiple participants through many significant statements (Table 6). These relationships included their interactions with nursing faculty, leaders in other disciplines, professionals in the clinical settings, and nursing students. As an example, the following quotes were provided by Participants 4 and 10:
Enjoying creative freedom These nurse leaders also enjoyed the opportunity to have creative freedom, as represented in the following quotations: “My lens has changed; people would say you are just so different, your mind is so different. You think differently, you see things differently, you're so
“…when I think about the variety of things I'm able to do every day—so many of them internally focused, many of them externally
Table 4 Title of participants.
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Table 5 Number of years in the role.
leadership”. Participant 13 stated “I really like this role. I like the variety, so it gives me an opportunity to interact with students [and] faculty across campus and have brainstorming sessions where we can think about how we can do things better”, “I am able to participate in discussions that are more university focused”, “I'm expected to look more for what's in the best interest and the greater good of the university at large”,
Table 6 Number of significant statements. Theme
Number of significant statements
Having a skillset Having a sense of calling Experiencing a variety of relationships Seeing positive change Enjoying creative freedom Enjoying professional growth Having support from administration Feeling overwhelmed with the number of hours/ duties Being coerced into the role Faculty shortage Lacking mentorship
113 98 236 91 28 72 43 232
“I feel a sense of ownership in faculty governance and being an active participant in the structure of the school” and “I get to talk with leaders in the community…it's out of my comfort zone so it's been a really good growth process for me”. (Participant 10)
75 72 59
Having support from the administration Support from the administration of the academic institution was also valuable to the nurse leaders' fulfillment in their roles. The following quotes demonstrate this aspect: “I have a boss who I have been able to, during the difficult times, kind of pull back and reflect with him…about even my own actions. I've been able to have conversations…and continue to learn from this person, which I certainly think impacts me” (Participant 13), Participant 7 stated “My boss was phenomenal”, “The role has been very supported” (Participant 15) and “I've felt tremendous support” was stated by Participant 18.
much more global in your perspective and I'm very proud of that” (Participant 3) and Participant 8 stated: “I can't sit in my office and create a chapter or lecture. I have to be in my happy place, which is usually my couch on a weekend or [in the] evening. There are places you can be creative, and times you can be creative. The role is much more than just meetings; it is developing a curriculum. I work when I feel the creativity coming from me, which is usually nights and weekends. It has to be during [a] time when you feel creative, you know?”
Negative factors that inhibited fulfillment: clouds
These quotes emulate that excitement of being a voice at the table, as well as a part of something outside of the department or college of nursing.
These themes are included because they are a part of the participants' personal journey in the role. Unfortunately, the participants expressed that these factors can impede their fulfillment.
Enjoying professional growth The academic nurse leaders also expressed an opportunity for the role to bring professional growth, which had a positive influence on their leadership skills. They described the joy of interacting others outside of the nursing college or department on a professional level and having a drive for a leadership position. They saw themselves as being part of decision making at the university level and representing nursing with other disciplines. There were 72 statements (Table 6) that led to this theme of enjoying professional growth, such as: “…This is kind of the role I always aspired to” (Participant 4), “I knew I wanted to be in a leadership role and so I felt good. I like it” (Participant 10), “I don't think you'd last terribly long in a role like this if you didn't love it because of the intense pressures in terms of time and time commitment…It is satisfying to me though” and “I initially got interested in administration …so it was a chance for me to really learn a lot about
Feeling overwhelmed with the number of hours and duties As described in the Review of the literature, academic nurse leaders have aspects of their position that are unique to nursing and bring additional stressors (Bouws et al., 2016). Some examples are lacking funding to support their research or their faculty's research agendas, the nursing faculty shortage, and the need for innovative curriculum. The nursing profession is now at the point in which the advancement of nursing knowledge, through scientific research, is disadvantaged by the tradition of grant monies being awarded to highimpact sciences, such as medicine, public health and pharmacy. Compared to other health disciplines, schools of nursing are among the lowest funded for research (National Institute of Health, Research Portfolio Online Reporting Tools, 2018), which continues to hinder the research productivity of the nursing profession. The amount of funding 5
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work and not enough time. I feel like I could just sit in my office and work from 7:00 AM to 7:00 PM, and maybe midnight even, seven days a week and I'd probably never get to do everything I want to do. I think it's the nature of being in an administrative position. I think people in other departments, other disciplines, would possibly say the same thing. With nursing, I think because we have external accreditation standards, we've got university requirements, we've got external constituencies, we've got over 800 clinical affiliation agreements. I have a lot of staff that help me, but it's just a big operation, so I don't know.”
depends on research productivity, and the nursing profession's relatively low level of funded research positions its capacity to influence practice and policy, based on scientific evidence, at a disadvantage. To ensure nursing competes effectively with other health-related disciplines, nursing leaders must find ways to help a greater proportion of nursing faculty excel as scientists and produce enough volume and quality of work. Many nursing leaders in academia expressed the frustration that they cannot complete their research agendas or do not have the means to support their faculty in that way. Participant 5 stated “Because I graduated with a PhD and have only had a couple of publications, I really need more. So that's been, that kind of upsets me because you need time and money to do that as well.”
Lack of mentorship Academic nurse leadership often comes into their role with little to no mentorship. These nurse leaders often seek out their own mentors and find they are lonely in the role due to the uniqueness of the nursing academic leaders' duties. This theme was evident even with the male participants of the study, as they had their own unique challenges in this role regarding mentorship. Participant 15 stated “I struggled with the male part of this role. People were not necessarily kind about it…it was other colleagues, other nurses.” Some other examples are: “You are a nurse and you are a man and how could you possibly perform this role?” “It is still something nursing has to work on. Nursing faculty have to work on stopping making men feel bad for wanting to be a nurse.” “Gender does play an effect because I approach things a lot differently than my female colleagues.” Participant 14 stated he felt “unprepared for this job”. “Nothing prepares you for this leadership position.” Participant 9 felt the same. They stated “I can tell you from my experience that we do not mentor new deans. We do not. We just eat each other up.” “They don't let you in ‘the group’ unless you are CCNE accredited.”
“I was jealous of other people. I'm watching them get grants or moving forward or getting any kind of scholarship. I just wasn't. I couldn't. It is all a juggle. Nursing all is a juggle anyway, and I just didn't have that scholarship ball that I could keep in the air there and I was jealous of other people getting published”. (Participant 16) There is a new vision to transform the education of nurses, so that they are relevant to the current advancement of science, technology, patient activism, the market-driven health care environment and the nature and settings of nursing practice (Benner, Sutphen, Leonard, & Day, 2010). To maintain this vision, the transformation of curriculum needs to employ innovative approaches to nursing education, rather than the current practice that is saturated in content (Giddens et al., 2008). The interprofessional education of nursing students is a current curriculum requirement that fosters a collaborative approach to patient care. Therefore, collaborative practice and interprofessional education is now an expected component of the curriculum of both medical and nursing schools. Nursing academic leaders are enhancing this concept throughout nursing courses in order to remain up to date, concerning professional practice (Makino et al., 2015). Clearly, this requires thoughtful time for leaders of nursing programs to not only consider curriculum transformation, but the influence it has on nursing faculties' workload assignments as well. Curriculum drivers, such as the Quality and Safety Education for Nurses (QSEN), the Essentials of Baccalaureate Education for Professional Nursing Practice (BSN Essentials) established by the American Association of Colleges of Nursing (AACN), the National Council for Licensure Examination for Registered Nurses (NCLEX) test plan and the upcoming changes in the BSN competency-based education are compelling schools of nursing to update their curriculum to comply with current standards in nursing practice. As a result, the nursing leaders faces the challenge of motivating and leading in a culture of change for nursing faculty—by creating educational environments (that foster professional attentiveness, responsibility and excellence) where students learn and have salient nursing practice (Benner et al., 2010). An example of this impact to that emulates the stress of mentoring faculty in this way is the following excerpt by Participant 17:
Being coerced in the role The participants expressed the emergence of this role in their professional careers as unexpected, being coerced or being “thrust into leadership” (Pearsall, Stiles & Horton-Deutch as cited in Berman, 2015 p. 298). These academic nurse leaders identified themselves in the role only after being recruited into leadership positions by others (Berman, 2015; Bouws et al., 2016). Participant 11 stated “my administrator heard of a position as director of nursing. She sent that information to me and it was not ‘you should apply’ it was more ‘I want you to apply’”. Participant 13 stated “Landing is exactly what happened. Landing is a good word because honestly, I didn't have the time for this role at all. That isn't something that I even have my sights on doing.” Faculty shortage Academic nurse leaders face the challenge of recruiting new nursing faculty, as the majority are nearing retirement. Nursing programs are turning away qualified applicants due to insufficient funds to hire new faculty and the unwillingness of administrations to commit to additional full-time positions. Another critical barrier to the faculty shortage is noncompetitive salaries. These leaders must recruit new nursing faculty while hospitals are dramatically increasing salaries for nurses (Bouws, 2018). In fact, according to an AACN report, from 2018 to 2019, 872 nursing schools reported full-time vacancies when they responded to a faculty vacancy survey (Rosseter, 2019). United States nursing schools have also turned away 75,029 qualified applicants from baccalaureate and graduate nursing programs because of an insufficient number of nursing faculty, classroom space or clinical sites, clinical preceptors and budget constraints. The majority of nursing programs admitted that insufficient funds to hire new faculty, along with the unwillingness of administration to commit to additional full-time positions were the main reasons they turned away qualified applicants (Rosseter, 2019). Additionally, nursing school deans face the daunting challenge of recruiting new nursing faculty, just as competition for the limited supply of nurses has forced hospitals to dramatically increase
“A lot of faculty that have master's degrees may be good in the clinical aspect, but they do not have a background in education. They have a background in clinical, so they come to me in that regard, not having any curriculum work, coming to me needing mentoring. They do not understand the power of active learning styles and strategies. They are talking heads, not a guide on the side.” The overall number of hours can be daunting as well as the variety of tasks the academic nurse leader is responsible for. Participant 11 stated: “I've been a chair, I've been a director, I've been a dean, no matter what the nurse role is, it just seems like there's always too much 6
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Recommendations for nursing education
salaries. Many graduates of nursing PhD programs are in their 30s and 40s and have mortgages, children and student loans, so the salary of a position is an important factor as they decide whether or not they will pursue a career in academia. The most critical barriers that schools reported, as they hired new nursing faculty, are noncompetitive salaries. In particular, they have difficulty hiring DNP/FNP nurses into faculty roles, due to high practitioner salaries (AACN, 2019). Participant 12 stated “they have been wanting me to increase our numbers and enroll more students. Well, I don't have all my courses covered for the fall as it is.” and from Participant 1:
Presently, the nursing profession is facing an employment crisis, as there is not only a shortage of nurses at the bedside, but a lack of nursing faculty and academic leaders as well. As this research study revealed, to ensure academic leaders feel fulfilled in their roles (regardless of their experience levels), the importance of retention and recruitment—as well as the ways in which they can enjoy smoother career transitions, particularly through the fostering of relationships—should not be overlooked. The importance of fostering relationships, guidance, support, and openness to change is pivotal to these academic leaders who are willing to step into the position. Many of these leaders seek to help of others in their state or through the AACN mentorship programs but found support from their faculty and upper administration is also important. Additional study on this phenomenon is warranted. Academic nurse leaders are a group of individuals who are part of an important social process that affects the retention and recruitment of other leaders in the nursing profession. As the United States faces a massive nursing faculty shortage (Rosseter, 2019), there is a need to address the leadership in schools of nursing across the country. It is critical—to the future of nursing—that enough aspiring leaders can successfully make this transition. In conclusion, similar research should continue in order to explore new methods of smoother career transitions, as well as the aspects of this role fulfillment, so that future nursing professionals will continue to accept academic leadership positions.
“it's really hard to get doctorally prepared nurses. We have more and more adjunct, it is really hard to get full time but then we are not going to have the richness we are not going to have the background of the other disciplines at the doctoral level that are going to expand the nursing science, I think there are going to be less nursing faculty that are research oriented.”
Discussion The theory that emerged from the data involves a social process of role fulfillment. The participants found that reaching out to others for assistance in adapting to their role as academic nurse leader, as well as having support from upper administration, collaborating with other professionals and mentoring others were pivotal for role fulfillment. Seven themes emerged as fulfilling to the academic nurse leader and four themes described aspects of the role that negatively impacted fulfillment. Fig. 1 depicts the theory as a tree. The trunk of the tree is inclusive of two themes which are intrinsic, within the academic nurse leaders' personality traits. Data revealed that having a skill set along with a sense of calling, are part of nurse leaders' dispositions. These factors were part of who they were as an academic nurse leader. The five leaves of the tree are extrinsic factors that enable fulfillment in the role which are outside of the participants' personality traits. The four clouds demonstrate themes that negatively impact fulfillment in the role.
Limitations Findings from this study were limited by the lack of gender diversity, as most of the participants were female. Yet, triangulation and maximum variation sampling would likely have been enhanced (Patton, 1990) if male nursing administrators had participated in this study. Furthermore, the geographical locations of the interviews were focused in one area of the. United States. This lack of diverse locale may be a limitation as well, as the process of interview, analysis and data organization, into themes
Fig. 1. The theory of role fulfillment in academic nurse leaders. 7
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and subthemes, was based on the findings of limited geographical regions.
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Recommendations for future research This study has contributed to the limited research on academic nurse leaders, aspects of fulfillment with their roles. The results of the data analysis indicated that these nurses in academia are leaders in the profession who have professional aspirations for their faculty and students, but have stressors that impact their role fulfillment. Although this study has revealed what those stressors entail, additional studies should be conducted to explore academic nurse leaders as they transition from novices to proficient and confident leaders that can serve as mentors to others. A more transitional, longitudinal study using a mixed method design could potentially result in a better understanding of the role, and the ways in which these leaders can implement more mentorship to facilitate smoother transition for future novice deans in later years. Declaration of competing interest None. Acknowledgements This work was supported by the Nyenhuis Professional Development Funds, Hope College, Holland, Michigan, USA. References American Association of Colleges of Nursing (AACN) (2019). DNP fact sheet. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Josey-Bass. Berman, A. (2015). Academic leadership development: A case study. Journal of Professional Nursing, (31), 298–304. https://doi.org/10.1016/j.profnurse.2015.02. 006. Blass, T. (2011). A nurse at heart: The journeys and experiences of nursing school deans (Doctoral dissertation). Available from. ProQuest Nursing & Allied Health Source (UMI No. 3472518). Bouws, M. (2018). The nursing dean role: An integrative review. Nursing Education Perspectives, 39, 80–84. https://doi.org/10.1097/01.NEP.0000000000000277. Bouws, M., Candela, L., & Bonnema, J. (2016). The novice nursing dean: A qualitative study of the lived experience. Journal of Nursing Education and Practice, 6, 43–51.
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