Identifying clinical scholarship guidelines for faculty practice

Original Articles Identifying Clinical Scholarship Guidelines for Faculty Practice KATHRYN FIANDT, DNS,* KATHLEEN BARR, PHD,† GAIL HILLE, MSN,‡ PEGGY PELISH, PHD,§ BUNNY POZEHL, PHD,㛳 POLLY HULME, PHD,¶ SUSAN MUHLBAUER, PHD,** AND STEPHANIE BURGE, MSN††

Clear descriptors of faculty practice and scholarly activities are essential to precisely demonstrate that the faculty practice role meets the standards of academic advancement and to influence academic policy. A description of scholarly clinical activities (1) justifies the benefits of faculty practice by means other than fiscal, (2) provides data for research regarding faculty practice, and (3) provides data to support the nursing profession’s political, social, and health care agendas. Guidelines for clinical scholarship are described in this article. A review of relevant literature demonstrates that these guidelines go beyond current models by describing 24 scholarly activities organized into 4 areas: quality, governance, leadership, and knowledge development. Three years of data describing the scholarly activities of a college of nursing faculty engaged in practice are presented to

*Associate Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. †Associate Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. ‡Instructor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. §Associate Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. 㛳Associate Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. ¶Associate Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. **Assistant Professor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. ††Instructor, University of Nebraska Medical Center, College of Nursing, Omaha, NE. Address correspondence and reprint requests to Dr. Fiandt: 985330 Nebraska Medical Center, Omaha, NE 68198-5330. E-mail: [email protected] 8755-7223/$30.00 © 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.profnurs.2004.04.008

demonstrate the effectiveness of the indicators in achieving these goals. These data can provide valuable information for trend analysis and, through heightened awareness of opportunities, increase faculty clinical scholarship activities. (Index words: Clinical scholarship; Faculty practice; Academic nursing practice) J Prof Nurs 20:147-155, 2004. © 2004 Elsevier Inc. All rights reserved.

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ACULTY PRACTICE HAS RECENTLY become a central component of the faculty role for advanced practice nurses. The scholarly nature of the role must be clarified. This article describes one school’s process of examining faculty practice and clinical scholarship. Clinical scholarship guidelines were developed and applied to the process of describing and quantifying scholarship in faculty practice.

Faculty Practice

There are many reasons why faculty engage in practice (Craig, 1996; Mundinger et al., 2000; Potash & Taylor, 1993; Sawyer, Alexander, Gordon, Jusczak, & Gilliss, 2000; Tolve, 1999). Rationales for faculty practice include (1) maintaining clinical expertise, (2) serving as role models while providing learning opportunities for students, (3) stimulating ideas and developing settings for research, and (4) providing health care services. Faculty in practice have can document and promote the advanced practice nursing role as a viable option within the health care delivery system (Christensen, Bohmer, & Kenagy, 2000; Mundinger et al., 2000). The definition of faculty practice continues to

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evolve. Before the development of academic nursing centers, faculty practice usually meant that a faculty member maintained an active practice by “moonlighting.” Potash & Taylor (1993), in the first conceptual exploration of faculty practice, defined faculty practice as “all aspects of the delivery of nursing service through the roles of clinician, educator, researcher, consultant, and administrator” (p. 2), thereby ensuring that all academic roles could be included in practice. Faculty practice must be clearly profiled as scholarly and embedded in the academic setting. The concept of faculty practice has expanded to include a focused commitment to all aspects of the faculty role (service, research, and education) and to incorporate all faculty into practice (Evans, Jenkins, & Buhler-Wilkerson, 1999). The National Organization of Nurse Practitioner Faculties’ (NONPF; 1997) Guidelines for Evaluation of Faculty Practice advises the following: Faculty practice is scholarly, which means at least that its staff members recognize the political, social, and economic context of health-care delivery; that they can think independently; that they can suspend judgment, and that they bring to their work a sense of inquiry. (p. 10)

Faculty practice has rapidly evolved from “moonlighting” to including all practice roles and embodying a commitment to an academic model in which scholarship is central (Evans et al., 1999). Faculty practices have often generated innovative nursing models developed to meet the challenges of the rapidly changing health care system of the 21st century. Faculty practicing in these models must apply their clinical scholarship skills to demonstrate how their nursing practices are providing care that is safe, effective, patient-centered, timely, efficient, and equitable (Institute of Medicine Committee on Quality of Healthcare in America, 2001). One School’s History

At the University of Nebraska Medical Center (UNMC) College of Nursing (CON), a Faculty Practice Committee (FPC) was formed in fall 1998 to support the role of faculty practice within the CON. The faculty of UNMC comprises over 100 members who are spread across 4 campuses and 500 miles. Nearly one-third of the faculty engages in practice involving contracts with outside agencies or practices in 1 of 5 CON nursing centers. Functions of the FPC include identifying and describing practice models in UNMC CON, disseminating information about these models, promoting faculty practice as

a dimension of the faculty role, and serving as a forum for addressing faculty practice issues or concerns. Early work of the FPC included developing a description of faculty practice reflecting the extant CON faculty practice activities. As part of the process of developing a functional definition of faculty practice, the FPC studied faculty practice literature, held brainstorming sessions, and designed avenues for faculty input. Subsequently, a definition was synthesized and approved by the faculty. Key components of the definition included the following: practice is incorporated into the workload, faculty are responsible for the outcomes of the practice, and practice is approached from a scholarly perspective (UNMC CON, 1998). This definition reflects three core concepts of faculty practice: workload, responsibility for outcomes, and clinical scholarship. The FPC decided that only practice within the faculty role, that is, as a part of workload, would be included in the faculty practice model. If faculty were to be held accountable for practice, and if practice was to be used to promote faculty advancement, it was deemed essential that the practice be recognized as a central component of the faculty member’s role. This decision eliminated including “moonlighting” into faculty practice. Responsibility for outcomes reflects the FPC belief that, for a practice to be considered “faculty practice,” faculty must be ultimately accountable for their practice activities. This belief precludes clinical teaching supervision as a component of faculty practice. Including both faculty practice as a workload component and faculty responsibility for outcomes in the definition served to clarify faculty practice. It also indicated a commitment by the FPC to look at practice in the broadest sense of faculty service, including consultation or practice with systems. Clinical scholarship is clearly an important part of faculty practice, with an inherent expectation that faculty will approach practice from a scholarly perspective (Diers, 1995). The importance of clinical scholarship in the CON is reflected in the strategic goal to increase clinical scholarship emanating from academic nursing clinical faculty practice. The FPC supported the assumption that one expectation of faculty practice is that the faculty member would, as appropriate, reflect the attributes of a scholar in his or her practice. Having accepted that practicing faculty should be accountable for scholarship in their practice, the FPC developed guidelines for clinical scholarship. The purposes of these guidelines were (1) to assist faculty in developing a scholarly practice, (2) to direct faculty in describing practice scholarship to assist with promotion and tenure, (3) to analyze trends in faculty practice scholarship in the CON, (4) to provide data for

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reports and grant writing, and (5) to develop a database available to CON faculty to study faculty practice. The FPC also identified underlying assumptions regarding clinical scholarship. First, clinical scholarship is more than research and is reflected in all aspects of practice. Second, clinical scholarship is a way of approaching the process of practice. Third, clinical scholarship is the best foundation for integrating research into practice. The FPC found the task of developing guidelines for clinical scholarship more challenging than developing the concepts of workload and responsibility for outcome. A literature review facilitated the defining and documenting of the scholarly aspects of practice.

Clinical Scholarship

Palmer’s (1986) historical perspective of clinical scholarship highlighted Nightingale’s emphasis on the art of observation and the necessity of reflection on those observations to predict future outcomes. Palmer stated that “even before the concept of clinical scholarship had been articulated, Nightingale stipulated its components: observation, education, experience and intellectual activity.” (pp. 318-319). Four assumptions were identified by Palmer as foundational to clinical scholarship: clinical scholarship (1) is based on observation of health-sickness phenomena, (2) entails extensive knowledge of nursing and other sciences used in the practice of nursing, (3) requires extensive clinical practice in nursing, and (4) demands the intellectual processes of thinking, analysis, and synthesis (p. 318). Boyer’s model of scholarship (Shoffner et al., 1994) is frequently used to describe nursing clinical scholarship (American Association of Colleges of Nursing, 1999; Pape, 2000; Shoffner et al., 1994; Tolve, 1999). Recognizing that basic research is not the only avenue to scholarship, Boyer used the paradigms of discovery, integration, application, and teaching to further elucidate areas of priority for scholarly pursuits. The scholarship of discovery includes research; the scholarship of integration provides for partnerships within and across disciplines so that knowledge can be transmitted and new knowledge can be generated (Elberson et al., 1996; Pape). The scholarship of application involves the interaction of theory and practice (Elberson, 1996). The scholarship of teaching is not only reflected in the transmission of knowledge but also can stimulate the expansion and reintegration of knowledge for teacher and learner alike. The American Association of Colleges of Nursing (AACN) has recognized that academic nursing often functions in areas designed to reward and promote a

narrow definition of success that has not included professional scholarship. The AACN (1996) acknowledges Boyer’s four areas of scholarship. The AACN described components of the scholarship of practice as including development of clinical knowledge, professional development, application of technical or research skills, and service. Examples of clinical scholarship identified by the AACN include conducting clinical research and evaluation, developing innovative health care delivery models, mentoring other professionals and students, initiating grant proposals, and developing practice standards. The Sigma Theta Tau International (STTI) Clinical Scholarship White Paper defined clinical scholarship as an approach that enables evidence-based nursing and development of best practices to meet the needs of clients efficiently and effectively (STTI, 1999). According to the STTI, the clinical scholar demonstrates the following characteristics: “a high level of curiosity, critical thinking, continuous learning, and the ability to use a spectrum of resources and evidence to improve effectiveness of clinical interventions” (p. 5). An example of clinical scholarship, identified by the STTI, is the development of clinical products and services. The FPC concluded that the literature reviewed defined clinical scholarship and provided good examples but lacked the clarity and specificity needed for the clear articulation of the faculty’s clinical scholarship. Guidelines for evaluating clinical scholarship needed to be developed. GUIDELINES OF CLINICAL SCHOLARSHIP

The FPC used brainstorming to generate ideas for guidelines of clinical scholarship based on the synthesis of our theoretical knowledge and clinical practice experience. After the brainstorming sessions, the initial draft of the guidelines was shared with practicing faculty, and feedback was elicited. Subsequently, the FPC held several meetings in which the guidelines were clarified. The resulting product (Table 1) is a set of 24 guidelines organized into four categories: quality, governance, leadership, and knowledge development. Quality

Quality is a central tenet of health care, and yet it cannot be assumed that all care is of the highest quality (Institute of Medicine Committee on Quality of Health Care in America, 2001). Accountability for quality in faculty practices is identified throughout the literature (Edwards, 1997; Markstrom & Fiandt, 1994; NONPF, 1997). The category of quality is based on the scholarly activity of application (Shoffner

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1. Clinical Scholarship Guidelines

Quality Demonstrates expertise as clinician Applies established standards Creates and implements mechanism for quality improvement in practice Utilizes program evaluation to improve practice Governance Demonstrates ownership of practice (autonomy and accountability) Practices independently and interdependently Demonstrates financial competence related to the business of practice Participates in management of practice Works to increase financial resources through development of service grants Participates in the development and implementation of the infrastructure to support the academic practice model within the College of Nursing Leadership Participates in national advanced practice standard development Mentors clinicians to develop scholarly clinical practice Mentors clinicians in developing their faculty practice role Serves as consultant on advanced practice and clinical issues Develops innovative advanced practice strategies Develops and maintains community partnerships for interdisciplinary relationships Participates in public relations/marketing for the advanced practice role and academic practice model Knowledge development Participates in research and development of conceptual models Develops and tests research-based protocols for advanced practice Develops and maintains collaborative initiatives for interdisciplinary research Demonstrates a commitment to grant writing with an emphasis on client outcomes and program evaluation Demonstrates and engages in outcome-based clinical practice with an emphasis on scientific rigor Tests community-based models with application to practice Publishes and makes presentations related to practice

et al. 1994) as described in the AACN paper. Although the literature reviewed by the FPC focuses on the importance of quality improvement programs in faculty practices, the guidelines developed by the FPC were designed to provide direction to individual faculty on how to demonstrate quality activities in their practice. The quality guidelines developed by the FPC include demonstrating expertise as a clinician, applying established standards of care to one’s practice, and actively participating in a quality improvement program. Governance

An essential component of faculty practice is nursing control (NONPF, 1997). An example of nursing control is fiscal accountability. Faculty in practice need to be aware of the financial aspects of their practice. In addition, fiscal accountability is central to the survival

of nursing center practice (Holman & Bransetter, 1997; Mackey & McNeil, 1997; NONPF, 1997). The category of governance is based on the scholarly activity of application (Shoffner et al., 1994). Guidelines for governance include demonstrating ownership of practice (i.e., autonomy and accountability), participating in the management of the practice, and writing service grants to increase funding for the practice. Leadership

Faculty practice provides the opportunity for leadership in nursing and the community. Leadership includes mentoring new leaders and developing and implementing innovative practice strategies (NONPF, 1997). Acknowledging the importance of disseminating information about innovative practice strategies, leadership guidelines include public relations and community partnership activities. The scholarly activities of teaching, integration, and application as described in the AACN paper (1999) are reflected in the leadership guidelines. Knowledge Development

Faculty practices at both the individual and population level are important sites for research that examines the structure, process, and outcomes of health care (Ingersoll, Hoffart, & Schultz, 1990). Outcomes of knowledge development support paradigm shifts and strengthen our capacity for affecting the political, social, and economic context of health care delivery. Knowledge development reflects the scholarly activities of discovery (Shoffner et al., 1994) and dissemination of new knowledge. The category also includes developing the evidence base for innovative models of practice. CLINICAL SCHOLARSHIP DATA COLLECTION

A primary goal of the development of the guidelines of clinical scholarship was to provide a measure of clinical scholarship activity as part of an effort to document faculty practice at UNMC. For 3 years, clinical scholarship data have been collected to describe faculty activities as reflected by the guidelines and to undergo trend analysis. Data were collected with an electronic questionnaire sent to the entire faculty body (N ⫽ 110). Achieving our goal of 100 percent of practicing faculty participation has been a challenge. In 2001, 17 of an estimated 32 faculty members (53 percent) identified as having a practice that meets the FPC definition completed the questionnaire. In 2002, the number of respondents increased to 23 (72 percent). In 2003, 22 practicing faculty members responded, and we expect that rate of response is the max-

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imum response rate feasible in any year. Efforts to increase participation have included an annual faculty practice workshop, giving each faculty member a personalized report summary, personal contacts with each practicing faculty member from FPC, and streamlining the data collection process. In 2001, of the 17 respondents, 13 (76 percent) were prepared at the doctoral level, and 4 (24 percent) were prepared at the master’s level. In 2002, of the 23 respondents, 16 (70 percent) were doctorally prepared, and 7 (30 percent) were prepared at the master’s level. In 2003, 15 (68 percent) were doctorally prepared and 7 (32 percent) were prepared at the master’s level. When asked if they had students in their faculty practice in 2001, 14 (82 percent) indicated that they did. In 2002, 21 (91 percent) and, in 2003, 17 (72 percent) indicated that they had students in their practice. In all 3 years, most students were nurse practitioner or clinical nurse specialist students, but there were also medical, physician assistant, social work, and pharmacy students as well as undergraduate nursing students. Each time data are collected, faculty are asked to provide descriptive data about their clinical practices (Table 2). Three years of descriptive data are useful in demonstrating the nature and scope of faculty practice in the CON. As reported in Table 2, most faculty indicate that they work with individual clients, although a sizable minority each year report that they work with groups and systems. The geographic diversity of CON faculty is reflected in practice sites that range from urban or inner city TABLE

Discussion

The FPC recognized from the beginning that clinical scholarship is not a series of unrelated activities but, rather, an integrated process of thinking and doing in the clinical setting that reflects the teaching, service, and research missions of academic education. The clinical scholarship guidelines were clearly effective in describing scholarly activities in faculty practice at UNMC CON. Data analysis showed that the quality guidelines were the most frequently reported, with some at over 90 percent in all 3 years, (e.g., “applies established standards”). This result reflects standard practice and supports the FPC expectation that all faculty practice conform to national norms. Governance guidelines indicate faculty involvement in the management of their practices. This category had several

2. Description of Practice: 2001, 2002, and 2003 Descriptor

Clients (may choose more than 1) Individuals Families Groups Systems Location of practice (may choose more than 1) Urban, not underserved Urban, inner city Town 25,000–50,000 Town ⬍25,000 Rural Practice in underserved area Provide Service to Underserved Vulnerable Populations Serveda Elderly (⬎85) Diverse Substance abuser Non–English-speaking Victims of abuse Migrants Mentally ill a

to rural and small-town practices. Perhaps most significant is that most faculty reported working with underserved people: 88.0 percent in 2001, 82.6 percent in 2002, and 86.0 percent in 2003. For each clinical scholarship guideline, faculty were asked to respond whether their practices included activities that reflected this guideline. An example was requested for each affirmative response. Tables 3, 4, 5, and 6 present the guidelines, the percentages of faculty who responded affirmatively, and representative examples from the 2001, 2002, and 2003 questionnaires.

Not asked in 2001.

2001 (n ⫽ 17)

2002 (n ⫽ 23)

2003 (n ⫽ 22)

16 (94.1%) 9 (52.9%) 6 (35.3%) 5 (29.4%)

20 (86.9%) 12 (52.2%) 6 (26.1%) 3 (13.0%)

19 (86.0%) 8 (36.0%) 8 (36.0%) 5 (23.0%)

6 (35.3%) 9 (52.9) 0 (0%) 2 (11.8) 0 (0%) 13 (77%) 15 (88%)

6 (26.0%) 8 (34.8%) 2 (8.7%) 3 (13.0%) 2 (8.7%) 15 (62%) 19 (82.6%)

5 (23.0%) 15 (68.0%) 5 (23.0%) 3 (14.0%) 2 (9.0%) 14 (64.0%) 19 (86.0%)

4 (17.4%) 12 (52.2%) 6 (26.0%) 6 (26.0%) 2 (8.7%) 2 (8.7%) 3 (13.0%)

5 (23.0%) 12 (55.0%) 5 (23.0%) 5 (23.0%) 1 (5.0%) 2 (9.0%) 3 (14.0%)

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3. Three Years’ Data on Quality Indicator of Clinical Scholarship Quality Indicators

2001

2002

2003

Example

Demonstrates expertise as clinician Applies established standards

15 (88.2%) 16 (94.1%)

19 (82.6%) 21 (91.3%)

21 (95.5%) 22 (100%)

Creates and implements mechanism for quality improvement in practice

10 (58.8%)

14 (60.8%)

14 (63.6%)

Utilizes program evaluation to improve practice

11 (64.7%)

15 (65.2%)

10 (45.5%)

Peer evaluation and certification American Nurses Association Standards for PsychiatricMental Health Clinical Nursing Practice Centers for Disease Control Sexually Transmitted Diseases Guidelines Implement evidence-based practice guidelines; evaluating the effectiveness of nurse practitioner case management of patients with diabetes Chart audits conducted and compared to standards

guidelines with higher percentages from 2001 to 2003, suggesting that faculty are becoming increasingly involved in the control of their practices. The leadership and knowledge development categories garnered fewer responses. Many UNMC CON faculty have been involved in faculty practice for 8 years or less. Perhaps this is insufficient time to develop the expertise needed for the mentoring, consultative, and creative aspects of leadership while simultaneously mastering clinical practice skills. Knowledge development activities are the least reported. This can also be attributed to the relative newness of faculty practice roles and the role stress that limits faculty time for creative work.

TABLE

The goals the FPC set to develop a database to describe clinical scholarship activities for reports and grants and to study faculty practice have been achieved. The guidelines have been used by the Promotion and Tenure Committee to evaluate portfolios of practicing faculty. Increases in the reporting of some activities are attributed to increased awareness of opportunities to participate in scholarly activities and thereby achieve the goal of assisting faculty to further develop clinical scholarship in their practice. We are 3 years into an ongoing data-collection process that will allow future analysis of trends. The FPC expects that the data will reflect growth in scholarship activities, assist in strate-

4. Three Years’ Data on Governance as Indicator of Clinical Scholarship Governance Indicators

2001

2002

2003

Examples

Demonstrates ownership of practice (autonomy and accountability) Practices independently and interdependently

11 (64.7%)

17 (73.9%)

19 (86.4%)

13 (76.5%)

20 (86.9%)

19 (86.4%)

7 (41.2%)

12 (52.2%)

15 (68.2%)

10 (58.8%)

17 (73.9%)

15 (68.2%)

6 (35.3%)

8 (34.8%)

3 (13.6%)

Manage Senior Health Promotion Center; coordinate all screening activities Collaborate with nurse practitioner peer group to provide services at student health; accept/initiate consultation and referral; work in an interdisciplinary student clinic with physicians, pharmacists, social work, medical technologists, and students Quarterly audits have been 100% on target; manage finances for practice grant; implement sliding scale for patients Attend staff meetings when appropriate; manage the practice (all nursing centers); attend/participate in clinic meetings Multiple examples related to grants written and received

7 (41.2%)

14 (60.9%)

16 (63.6%)

Demonstrates financial competence related to business practice Participates in management of practice Works to increase financial resources through development of service grants Participates in the development and implementation of the infrastructure to support the academic practice model within the College of Nursing

Membership on faculty practice and/or College of Nursing Clinical Enterprise Committee; attend faculty practice workshops

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TABLE

5. Three Years’ Data on Leadership as Indicator of Clinical Scholarship Leadership Indicator

2001

2002

2003

Participates in national advance practice standard development

3 (17.6%)

5 (21.7%)

4 (18.2%)

Mentors clinicians to develop scholarly clinical practice Mentors clinicians in developing their faculty practice role

9 (52.9%)

9 (39.1%)

9 (41.0%)

3 (17.6%)

6 (26.1%)

3 (13.6%)

Serves as consultant on advanced practice and clinical issues

8 (47.1%)

8 (34.8%)

8 (36.4%)

Develops innovative advanced practice strategies

4 (23.5%)

6 (26.1%)

4 (18.2%)

Develops and maintains community partnerships for interdisciplinary relationships

6 (35.5%)

6 (26.1%)

7 (32.0%)

Participates in public relations/ marketing for the advanced practice role and academic practice model

2 (11.8%)

10 (43.5%)

10 (45.5%)

Examples a

A WHONN Professional Development Committee; position on NANDAb Diagnostic Review Committee; review APNAc psychiatric nursing diagnoses and standards of care; member Expert Panel American Nurses Credentialing Center Community/ Public Health practice Mentoring new faculty clinicians Mentored 2 clinicians in healing touch; advise clinicians on their practice Smoking cessation; healing touch; psychiatric nurse practitioner role development at local hospital; member state critical access hospital task force Created and developed the Senior Health Promotion Center; developed diabetic screening; developed perimenopausal screening tool Nebraska Health System Diabetes Education Program Advisory Board; Work with College of Dentistry and Area Office on Aging; Health Advisory Committee for Omaha Head Start Multiple radio/television interviews; articles in Lincoln Journal Star re: Lincoln Senior Health Clinic; coproduced 2 /public-service announcements regarding nurse practitioners; multiple speakers for community programs

a

AWHONN, Association of Women’s Health, Obstetric, and Neonatal Nurses. NANDA, North American Nursing Diagnosis Association. c APNA, American Psychiatric Nurses Association. b

gic planning, and serve as a database for faculty practice research. THE FUTURE OF CLINICAL SCHOLARSHIP IN FACULTY PRACTICE

The FPC believes that academic nursing, through clinical scholarship activities, has the potential to provide significant leadership in addressing quality and access problems in health care today. In their article on improving health care, Becher and Chassin (2001) suggest that leadership should come from “academic medicine,” but they conclude that academic medicine is focused on biomedical research and medical education and, therefore, fails to exert significant leadership. Becher and Chassin failed to consider the potential for academic nursing as a source of leadership for health care change. Certainly academic nursing cannot im-

prove health care quality alone, but we can provide leadership. One source of that leadership is clinical scholarship in faculty practice. Nursing practice models, especially in advanced practice nursing, bring essential expertise to the health care arena that addresses both quality and access problems. Clinical scholarship activities are an important vehicle for studying and articulating these skills. The data derived from these scholarly activities are needed to describe nursing’s relentless commitment to our patients and to highlight the particular ability of nurses to address the complex needs of people and systems. THE FUTURE OF FACULTY PRACTICE RESEARCH

Limited amounts of evidence exist to support the value of faculty practice to the mission of the academy. Several

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6. Three Years’ Data on Knowledge Development as Indicator of Clinical Scholarship Knowledge Development

2001

2002

2003

Examples

Developed healing touch assessment tools; developing a model for behavioral change and lifestyle management for cardiovascular disease risk reduction; developing/testing a risk adjustment model; developing a model of family of person with mental illness responses/needs Effect of exercise on heart failure; tested phone interventions with tobacco addiction Collect/analyze evaluation data on interdisciplinary student-run clinic; collaborate with pharmacy and respiratory therapy for intervention model Health care trust fund grant; Partnership in Quality Education grant; UNMC Hospital Auxiliary grant; UNMC seed grant Modified types of health screening and health education programs offered based on data re predominant health problems of population compared health care utilization costs (of employees enrolled in a health benefits plan) with involvement in health program activities demonstrating participation lowered health care costs Access Medicaid Clinical Practice Improvement Project

Participates in research and development of conceptual models

6 (35.3%)

11 (47.8%)

10 (45.5%)

Develops and tests research-based protocols for advanced practice Develops and maintains collaborative initiatives for interdisciplinary research

2 (11.8%)

5 (21.7%)

5 (22.7%)

5 (29.4%)

3 (13.0%)

5 (22.7%)

Demonstrates a commitment to grant writing with an emphasis on client outcomes and program evaluation Demonstrates and engages in outcomebased clinical practice with an emphasis on scientific rigor

9 (52.9%)

7 (30.4%)

5 (22.7%)

3 (17.6%)

6 (26.1%)

4 (18.2%)

Tests community-based models with application to practice Publishes and makes presentations related to practice

1 (5.9%)

1 (4.3%)

2 (9.0%)

11 (64.7%)

9 (39.1%)

10 (45.5%)

research areas can be identified from the current body of literature on faculty practice. Many of the questions address pedagogy and include questions such as the following: What is the impact of faculty practice on student outcomes? Are students socialized by their exposure to practicing faculty or to service learning? To working with vulnerable people? To independent nursing practices? The data are not available to address these and other pedagogical questions regarding the impact of faculty practice on student outcomes. Other related research questions address role stress and the impact of practice on academic performance from a faculty perspective—for example, what is the relationship between research productivity/ publication and faculty practice? Research questions about the nature and outcome of advanced practice nursing are of particular importance and are in the domain of faculty practice for several reasons. First, most independent nursing practices and nursing centers are based in academic settings. Second, the research resources exist in the academy. Finally, faculty practice settings should reflect innovative practice models. This third area raises interesting conundrums because many faculty practices provide care to underserved people in settings with limited resources. In these practices, financial problems can constrain clinicians from providing standard types of care but result in the development of innovative strategies to provide quality care with limited resources. Therefore, important aspects of the research

Multiple publications, presentations, and papers

should include risk adjustment (Maas & Kerr, 1999), the unique needs of vulnerable populations (Zachariah & Lundeen, 1997), and the unique skills of advanced practice nursing in working with these vulnerable populations (Fiandt, 2002; Mundinger et al, 2000). Additional essential research questions would address cost issues (Storfjell, 1997), the importance of descriptive data (Sawyer et al., 2000), and database development (Palladino & Dower, 1997). Faculty practice is also a fertile area for health services and nursing services administration research. These areas of research would allow faculty who practice at the system and population levels to combine faculty practice, research, and program development. Innovative advanced practice nursing models, the quality of health care, and the cost of health care are understudied areas of research. (Bradham et al., 2000; Ingersoll et al., 1990). Research in and about the scholarly aspects of faculty practice is essential for the evolution of the profession. Faculty must move beyond faculty practice goals related to clinical expertise and teaching to research goals focused on the nature of advanced practice nursing. The results of this research can then support a social and health care policy agenda to promote legislation for advanced practice nursing and to assure access to quality care for all people.

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Conclusion

The work done by the FPC to describe clinical scholarship in UNMC CON is an important contribution to academic nursing. On a pragmatic level, the clinical scholarship guidelines provide quantifiable markers to support promotion and tenure and also provide data for reports, grants, and research. Addi-

tionally, the guidelines assist faculty as they evaluate and seek to expand scholarly activities in their practices. These scholarly activities will serve as a rich source of knowledge about advanced practice nursing and have the powerful potential to affect the social, economic, and political context of health care (Christensen, Bohmer, Kenagy, 2000; Fiandt, 2002; Marion, 1997; Markstrom & Fiandt, 1993).

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