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Issues facing nurseteachers on the pre-registration diploma of higher education course (Project 2000): a case study approach
Issues facing nurse teachers on the pre-registration
diploma of higher education course (Project 2000): a case study approach Sada Camiah
Sada Camiah MPhi], BEd(Hens), RGN, RNT, CertEd(FE), Senior Lecturer, Department of Acute Health Care, University of Luton, Bedford
Campus, BritanniaRoad, Bedford, UK (Requests for offprints to SC) Manuscript accepted 24 November 1995
This paper draws on the experience and expertise of nurse practitioners and teachers of nurses to report on significant issues facing the latter in their work. The findings form part of a larger study describing major changes in the role and work of nurse teachers resulting from Project 2000 initiatives. The rationale for adapting a case study approach is outlined. The results indicate that changes in the work of nurse teachers and diversity of activities expected has placed some major obstacles in their work. Nurse teachers were perhaps inadequately prepared for their new roles, given the haste required by the demonstration nursing schools in their curricular submission documents in order to compete for approved course recognition (Project 2000) and demonstration status. The study recommends extensive staff support, development and academic growth, and continuing commitment to steady progress and change.
INTRODUCTION The role of nurse teachers in the U K is currently undergoing significant changes as a
Nurse EducationToday(1997) I1, 203-208 © 1997PearsonProfessionalLtd
result o f Project 2000 initiatives. This is a British Government initiative to move nurse education into higher education with a view to better preparing current and future student nurses to meet the changing health care needs o f society in the 1990s and beyond (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, U K C C 1986). Attempts to move away from the traditional form o f nurse preparation and training towards A New Preparation For Practice ( U K C C 1986) have resulted in greater demands and considerable challenges being placed upon nurse teachers. As already reported in the Department of Health (DOH) 1989 circular, the role of nurse teachers would become more complex and diverse. Nurse tutors would be expected to assume an increased role in teaching in practice settings and to be qualified or clinically credible in the area of practice taught ( D O H 1989). Thus, in anticipation of new demands being placed upon nurse tutors, and nursing moving into the realm of higher education, it was felt that many tutors would find it di~cult to make the necessary transitions without adequate preparation and staff development. The purpose of this paper is to draw on the experiences and expertise of nurse practitioners and nurse teachers to report on some of the main issues seen to have impinged on the latter in their work. The paper forms part o f a larger study describing significant changes in the role of nurse tutors resulting from Project 2000 initiatives (Camiah 1994).
LITERATURE REVIEW At the outset of this study, hardly any literature was available examining changes in the role and work of nurse teachers brought about by implementation of the new diploma of higher education (Project 2000) and the likely issues facing nurse teachers at work. This study was undertaken following nomination o f 13 demonstration schemes to pilot the first preregistration Project 2000 courses. It was the first of its kind. Previous studies (Nolan 1987, Ingleston 1990) into the activities of nurse teachers responsible for traditional nursing courses had indicated that nurse teachers were seen to fulfil a wide range o f teaching and administrative activities, with the latter being viewed as less positive aspects o f their work. Gott (1982) and Clinton (1982) affirmed that a significant number of nurse teachers were failing to develop and stimulate critical thinking and creativity in students. T h e y argued that nursing students were actively
204
NurseEducation Today
discouraged from raising questions or from arguing their position logicaily, in an attempt by educators to retain power through the possession o f knowledge. Sweeney (1986) claimed that if the traditional asymmetrical power relationship o f tutors was not questioned, nursing practice would suffer. Sims & House (1976) highlighted the need for nurse teachers to be better prepared for the activities within their role. They noted that nurse teachers were expected to teach a wide range o f topic areas for which they were inadequately prepared. The need for student nurses and nurse teachers to be better prepared was emphasized in various reports (Briggs •972, English National Board for Nursing, Midwifery & Health Visiting (ENB) 1987, U K C C 1986).
the author over a 15-month period. Access to key stakeholders, namely nurse teachers and senior nursing directorate, was negotiated with heads of nursing departments or institutions of higher education and chief nursing officers. The main method o f data collection was in-depth semi-structured interviews supported by group discussions. The research interviews took account o f radical and rapid changes in both the organization and management o f nursing schools and the National Health Service (NHS). They were both exploratory and investigative. Attempts were made to identify and possibly agree on significant issues by asking interviewees and group participants to reflect on their own experience and views. Sample
METHOD Data
collection
A case study approach using qualitative and quantitative techniques was adopted for this study. Two demonstration Project 2000 pilot schemes were chosen to provide contrasts. The differences included: the fact that one was located in the North and the other in the South of England; patterns of educational organization and management; types and fi-equency of student intake; and pre-registration programmes in terms of module planning, implementation and development. The two districts reflected the variety of educational and management models emer~ng in nursing schools. The aim o f these case studies was to try to obtain as objective a view as possible of what was going on in more than one district and to access the main strands of experiences and expectations of key informants in the demonstration schools. W o r k on the detailed design, preparation and pilot work accounted for the first 8 months of the study. A series o f formal and informal discussions was then undertaken to set up and facilitate the fieldwork. The fieldwork with key informants was carried out by
Educationalrespondents (n = 73)
%
Heads of nursingschools Senior nurse tutors Nurse teachers Higher education lecturers
8 68
ENB officers
Total
6
15 3 I O0
Servicerespondents (n = 42)
"%
Chief nursingofficers
6 I0 14 69
Clinicalnursingdirectorates Senior nurse practitioners Ward sisters/chargenurses Total
100
of interviews
The sample consisted of key knowledgeable informants from both the educational sector and the service provider units. A total of 115 respondents was involved, comprising 73 educational staff, about half from each district, and 42 service staff, all but 6 from one district. Table 1 shows the sample characteristics of the key informants. Priority by groups were mainly nurse tutors, college lecturers and senior nurses. A small percentage was made up of heads of nursing schools, chief nursing directorate and officers from the ENB. In essence, perceived problems for nurse teachers at work were examined from two main perspectives: educational and service. Such an approach was considered useful in providing a check on the accuracy of data and a framework for assessing the validity of the evidence obtained from the different parties. This notion was expounded by Diesing (1972), who claimed that the validity of a piece of evidence could only be increased by comparing it with comments of a similar kind or remarks of a similar nature made by different parties. Data
analysis
Data were analysed using a modification of content analysis. All interviews were transcribed by the investigator using models highlighted by Coulthard (1978). The criteria used for the selection o f material for transcription included the relevance to the focus o f the study, the length o f segments on tape and the audibility o f recording. Qualitative data were divided into four broad categories, each with subcategories. The main groups were issues attributed to patterns o f educational organization and management, teaching and learning, administration and professional development.
Issues facing Project 2000 nurse teachers
FINDINGS W h e n asked what they saw as the main obstacles that obstruct nurse tutors in their work, and what aspects of the changes in the role of nurse tutors might be most problematic, respondents gave three main responses to each question. Tables 2 and 3 enumerate the number of responses and not the number of respondents. As illustrated in Tables 2 and 3, analysis of data showed that the main issues identified and the thinking that lies behind them remained more or less the same for the two groups but with a different weighting attached to them. For example, it was noted that professional development issues became more prominent in the light of Project 2000 course implementation. More detailed qualitative analysis o f the data yielded the following insights.
Educational management Responses about educational organization and management issues were mainly concerned with: role ambiguity; poor time management on the part of nurse teachers; ineffective management styles o f heads of nursing schools; too much bureaucracy; inability of nurse tutors to translate the curricular contents into practice; and nurse tutors having to work closely with staff in institutions of higher education on joint course planning and development. Fewer respondents identified poor working relationships and ineffective liaison with the service provider units as major obstacles in the work o f nurse teachers.
205
The most frequently cited reasons for role ambiguity were poor job description and unclear lines of responsibility and accountability. Many nurse teachers claimed that having to work and report to two or more senior managers put them under many pressures. In essence, they argued that different managers had different expectations of their role and therefore made conflicting demands upon them. This may reflect the consequence of a rapid continuing reorganization of nursing schools. U n d e r the heading of poor time management, a n u m b e r of respondents claimed that nurse tutors seemed to be spending too m u c h time on course planning, administration and paperwork, leaving them with little or no time for seeing students in practice areas. Such views seemed to be shared widely by both senior nurse educators and senior nurse practitioners, indicating that perhaps nurse teachers should prioritize their time more effectively. O n the other hand, several nurse teachers claimed that having a heavy workload in terms o f curriculum innovations, and new expectations placed upon them, militated against them spending sufficient time with students in practice settings. Others saw their priorities as having a more pastoral and supportive role to students and their mentors. Comments about ineffective management styles of heads of nursing schools and red tape bureaucracy implied a reluctance on the part of nurse managers to bring about radical changes swiftly. There were also comments regarding attendance at too many meetings with no clear
Issues
Viewpoints Educational respondents, districts A and B (%)
Educational organization and management Professional development Administration Teaching and learning Total
5I 22 19 7 100 (n = 219)
45 27 15 12
48 25 17 l0
I00~= 126)
lO0 ~ = 345)
Educational organization and management Professional development Administration Teaching and learning Total
37 32 17 14 100 (n = 219)
36 28 24 12 100(n = 126)
36 30 20 13 100~ = 345)
Service respondents districts A and B (%)
All respondents (%)
206 NurseEducation Today objectives, and inflexible working hours. As one respondent put it: You heard managers talking about changes but when you offer new suggestions, you get ignored and pushed aside ... Regarding tutors experiencing difficulties in translating the curricular contents into practice, and hence in translating the 'knowledgeable doer' and the 'reflective practitioner' into actual learning experiences, the most frequently cited reasons were inadequate staff development and unfamiliarity with the new document. It was interesting to note that a number o f nurse teachers admitted that they were initially ignorant about what a course outcome at, for example, level 2 should be and h o w such an outcome differed from level 3. As far as joint course planning and development were concerned, a minority o f respondents claimed that such a move could leave nurse tutors feeling like 'a small fish in a large tank', indicating that perhaps several tutors feared being taken over by higher education, an event which they did not see as promising. It must be argued that not all respondents saw the integration o f nurse education into higher education as problematic. Many claimed that it could benefit both nurse teachers and higher education staff: A comment from one staff member was: Maybe the links with higher education would enable both nurse teachers and college lecturers the opportunity to share views and to learn from each other on matters such as course planning and development and for nurse teachers to teach across other departments and have access into higher education. Other interviewees argued that it is essential for nurse education to maintain close links with higher education and the service provider units, otherwise it will distance itself from higher education and the service needs. This suggests the need for nurse teachers to establish effective links with higher education and the service sector for their own survival.
Professional development Key issues identified under the heading o f professional development were: a lack o f opportunities for tutors to undertake further and higher education courses; inability o f some tutors to keep uptodate with the pace o f change and its magnitude; failure o f a significant number o f nurse teachers to develop effectively and implement the nursing curriculum, and to undertake and disseminate research findings. The most frequently cited reasons for failure o f nurse teachers to gain access into higher education
were 'professional barriers' set up by certain individuals, and the 'pecking order' within an organization. Also seen as a major obstacle by several respondents was the lack o f academic skills and clinical credibility o f some nurse educators. O n e said: Teachers o f nurses have often been retro active than pro active; they wait for things to happen and when it happens they stamp on it. It's like a conveyor belt ... Such remarks suggest that there is a need for tutors to b e c o m e more self-assertive and to gain higher academic qualifications with a view to p r o m o t i n g nursing as an academic discipline. Failure o f tutors to translate effectively the curricular contents into practice was linked with lack o f academic skills and staff development. It was interesting to note that a large number o f nurse teachers themselves claimed that they would have liked to have more time and preparation for certain new activities expected o f them. Many mentioned their own lack o f research awareness but were reluctant to comment further about it. Such views were shared by a number o f service respondents: a fact that indicates an urgent need for a majority o f nurse teachers to undertake an intensive staff development programme, and for them to be given adequate support by their superiors.
Administration Administration issues embraced mainly lack o f resources, with a few responses referring to travel and clerical work. The main reasons given were: classroom sizes were too small to accommodate large groups o f 60+ students; little thought went into accommodating large groups o f students on one site; library facilities were poor, as students could not always get the books they wanted; and there were not enough photocopying facilities in the school. A typical comment was: what a waste o f time going up and down the ro ad. Also seen as an administrative issue, though to a much lesser degree, was the fact that tutors were having to compete for scarce resources and to market their courses: developments which many respondents saw as problematic.
Teaching and learning Responses about teaching and learning issues were directed mainly at teaching approaches, assessment o f students' learning and supervision o f students' work, particularly in clinical settings. The factors most frequently cited were a
Issues facing Project 2000 nurse teachers
reluctance on the part of nurse tutors to move away from conventional face-to-face teaching towards an open learning mode of study, for example, computer-assisted learning, and a more student-centred approach to teaching. A significant number of respondents also claimed that a reluctance on the part of many tutors to relinquish teaching a wide range of topic areas or to give up ownership of courses, presented an obstacle to their work. It was interesting to note that several nurse teachers claimed that they would value staff development programmes on alternative teaching and learning approaches. Assessment issues were referred to as poor understanding of devolved continuous assessment of theory and practice, and improper usage of the grading profile by nurse tutors: a fact reflecting a need for continuing staff development. Comments about supervision of students' work included inadequate tutor/student contact time, poor support and supervision of students in practice areas, and tutors increasingly becoming de-skilled: facts that call for increased supervision of students' work in dinical settings and for tutors to move towards specialist work areas.
DISCUSSION
The results indicated that a significant number of nurse teachers experienced obstacles in their work. The main difficulties perceived were failure of a majority of nurse tutors: to move towards a more progressive approach to teaching and learning; to gain adequate support in the pursuit of further and higher education; to prioritize and manage their time effectively; to gain greater academic skills and credibility; and to be more credible in clinical practice. The study also indicated that lack o f adequate resources, such as availability of classrooms of the correct size and the provision of sufficient library books, inhibited many nurse teachers in their work. If we require nurse teachers to change and diversify their work activities as a result o f Project 2000 initiatives, then we need to give them the support they require. This could be best achieved through a comprehensive staff development programme, and opportunities for a greater number of staff to attend further and higher education courses relevant to their preferred areas of interest. The study also highlighted issues relating to educational organization and management, teaching and learning. This indicates the need for senior nurse educationists to be more supportive and flexible in their approach to management, for nurse teachers to be more proactive and adaptable to the change process, and for nurse teachers and
21)7
senior educationists to discuss problems openly. Such facts also call for criticism to be dealt with more constructively and for teachers of nurses to be given the opportunity for individual responsibility, accountability and some degree of autonomy in terms of decision-making. The study also identified issues concerning role expectations and hence the need for nurse teachers to re-examine the work they do. For example, this would include looking closely at their present job description to see whether it is relevant to the role and work they are doing or expected to do in the light o f Project 2000 course implementation. The study suggests a radical review of the nurse teacher's role and job descriptions. Suggestions for a joint teacher-practitioner appointment may be seen as a positive step for a significant number of future nurse teachers to take. This may help to address the issue o f students being inadequately supervised in clinical settings, but the question o f h o w nurse teachers should spend their time and h o w much time should be spent in clinical practice ought to be further explored. The author believes that, if the above are not addressed, someone will soon question the existence of nurse teachers, or at least marginalize them. Administration issues were also perceived as a barrier, suggesting that essential requirements like availability o f proper size classrooms and adequate numbers of library books should be in place in order to atlow tutors to carry out their work in an effective manner. The findings also showed that certain activities, like research, marketing, and supervision of students' work in practice settings, either received a low ranking or were seen as unwelcome developments. There would thus seem to be a need for further research on the preparation required of future nurse teachers. It appears essential that nurse teachers learn to compete for scarce resources and to develop a greater awareness of nursing research, marketing and supervision of students' work in practice settings. The study concludes that barriers in the work of nurse teachers could only act as an inhibiting agent to the change process. As indicated by Towell 8: Harries (1979) and Docking (1980), an educational environment is ripe for change when the following conditions coexist: openness; good interpersonal relationships; effective communications; freedom from organizational constraints; supportive leadership; and trust. In conclusion, in the light of this study, it can be argued that major barriers in the work o f nurse teachers can be dealt with effectively through the following: •
Continuing staff development and academic growth in terms of time management,
208
NurseEducation Today
curricular innovations, research, m a r k e t i n g and alternative m o d e s o f study •
A revision o f j o b description for nurse teachers
•
N u r s e teachers learning to prioritize their w o r k and to c o m p e t e for scarce learning resources
•
N u r s e managers b e i n g m o r e supportive and flexible in terms o f educational organization and m a n a g e m e n t
•
N u r s e e d u c a t i o n c o n t i n u i n g to m a i n t a i n effective links w i t h h i g h e r e d u c a t i o n and the service p r o v i d e r units
•
P r o v i s i o n o f adequate learning resources to facilitate nurse teachers to fulfil effectively the role e x p e c t e d o f t h e m .
ACKNOWLEDGEMENTS I would like to thank University of Luton colleagues Dr John Paley and Professor David Berridge for their comments on the manuscript.
REFERENCES Briggs Report 1972 A reform of nurse education: first report of a special committee on nurse education. Royal College of Nursing, London Camiah S 1994 The chan~ng role of nurse teachers: a study within two demonstration Project 2000
districts. Unpublished MPhiI thesis, Crantield University Clinton M 1982 Training psychiatric nurses towards a sociological analysis of the hidden curriculum. Nursing review 3:4-6 Coulthard M C 1978 An introduction to discourse analysis. Longman, London Department of Health 1989 Working for patients, education and training, paper 10. HMSO, London Diesing P 1972 Patterns of discovery in the social sciences. t~outledge Kegan Paul, Henley-onThames Docking S P 1980 Innovation in nurse education: the introduction of the nursing process in the nursing curriculum. MA thesis, London University English National Board for Nursing, Midwifery & Health Visiting i987 Course approval process: rules, regulations and guidelines. ENB, London Gott M 1982 Theories of learning and the teaching of nursing. Nursing Times 11:41-44 Ingleston L 1990 Teachers opinions of their role. Unpublished survey, United Midlands College for Nursing and Midwifery, Wolverhampton Nolan P,. 1987 Nurse teachers at work. Unpublished PhD thesis, University of Cardiff Sims A, House V 1976 Teachers of nursing in the United Kingdom: a description o£their attitudes. Journal of Advanced Nursing 1:495-505 SweeneyJ F 1986 Nurse education: learner centred or teacher centred? Nurse Education Today 6:257-262 Towell D, Harries C 1979 Innovation in patient care. Croom Helm, London United Kingdom Central Council for Nursing, Midwifery & Health Visiting 1986 Project 2000: a new preparation for practice. UKCC, London
diploma of higher education course (Project 2000): a case study approach Sada Camiah
Sada Camiah MPhi], BEd(Hens), RGN, RNT, CertEd(FE), Senior Lecturer, Department of Acute Health Care, University of Luton, Bedford
Campus, BritanniaRoad, Bedford, UK (Requests for offprints to SC) Manuscript accepted 24 November 1995
This paper draws on the experience and expertise of nurse practitioners and teachers of nurses to report on significant issues facing the latter in their work. The findings form part of a larger study describing major changes in the role and work of nurse teachers resulting from Project 2000 initiatives. The rationale for adapting a case study approach is outlined. The results indicate that changes in the work of nurse teachers and diversity of activities expected has placed some major obstacles in their work. Nurse teachers were perhaps inadequately prepared for their new roles, given the haste required by the demonstration nursing schools in their curricular submission documents in order to compete for approved course recognition (Project 2000) and demonstration status. The study recommends extensive staff support, development and academic growth, and continuing commitment to steady progress and change.
INTRODUCTION The role of nurse teachers in the U K is currently undergoing significant changes as a
Nurse EducationToday(1997) I1, 203-208 © 1997PearsonProfessionalLtd
result o f Project 2000 initiatives. This is a British Government initiative to move nurse education into higher education with a view to better preparing current and future student nurses to meet the changing health care needs o f society in the 1990s and beyond (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, U K C C 1986). Attempts to move away from the traditional form o f nurse preparation and training towards A New Preparation For Practice ( U K C C 1986) have resulted in greater demands and considerable challenges being placed upon nurse teachers. As already reported in the Department of Health (DOH) 1989 circular, the role of nurse teachers would become more complex and diverse. Nurse tutors would be expected to assume an increased role in teaching in practice settings and to be qualified or clinically credible in the area of practice taught ( D O H 1989). Thus, in anticipation of new demands being placed upon nurse tutors, and nursing moving into the realm of higher education, it was felt that many tutors would find it di~cult to make the necessary transitions without adequate preparation and staff development. The purpose of this paper is to draw on the experiences and expertise of nurse practitioners and nurse teachers to report on some of the main issues seen to have impinged on the latter in their work. The paper forms part o f a larger study describing significant changes in the role of nurse tutors resulting from Project 2000 initiatives (Camiah 1994).
LITERATURE REVIEW At the outset of this study, hardly any literature was available examining changes in the role and work of nurse teachers brought about by implementation of the new diploma of higher education (Project 2000) and the likely issues facing nurse teachers at work. This study was undertaken following nomination o f 13 demonstration schemes to pilot the first preregistration Project 2000 courses. It was the first of its kind. Previous studies (Nolan 1987, Ingleston 1990) into the activities of nurse teachers responsible for traditional nursing courses had indicated that nurse teachers were seen to fulfil a wide range o f teaching and administrative activities, with the latter being viewed as less positive aspects o f their work. Gott (1982) and Clinton (1982) affirmed that a significant number of nurse teachers were failing to develop and stimulate critical thinking and creativity in students. T h e y argued that nursing students were actively
204
NurseEducation Today
discouraged from raising questions or from arguing their position logicaily, in an attempt by educators to retain power through the possession o f knowledge. Sweeney (1986) claimed that if the traditional asymmetrical power relationship o f tutors was not questioned, nursing practice would suffer. Sims & House (1976) highlighted the need for nurse teachers to be better prepared for the activities within their role. They noted that nurse teachers were expected to teach a wide range o f topic areas for which they were inadequately prepared. The need for student nurses and nurse teachers to be better prepared was emphasized in various reports (Briggs •972, English National Board for Nursing, Midwifery & Health Visiting (ENB) 1987, U K C C 1986).
the author over a 15-month period. Access to key stakeholders, namely nurse teachers and senior nursing directorate, was negotiated with heads of nursing departments or institutions of higher education and chief nursing officers. The main method o f data collection was in-depth semi-structured interviews supported by group discussions. The research interviews took account o f radical and rapid changes in both the organization and management o f nursing schools and the National Health Service (NHS). They were both exploratory and investigative. Attempts were made to identify and possibly agree on significant issues by asking interviewees and group participants to reflect on their own experience and views. Sample
METHOD Data
collection
A case study approach using qualitative and quantitative techniques was adopted for this study. Two demonstration Project 2000 pilot schemes were chosen to provide contrasts. The differences included: the fact that one was located in the North and the other in the South of England; patterns of educational organization and management; types and fi-equency of student intake; and pre-registration programmes in terms of module planning, implementation and development. The two districts reflected the variety of educational and management models emer~ng in nursing schools. The aim o f these case studies was to try to obtain as objective a view as possible of what was going on in more than one district and to access the main strands of experiences and expectations of key informants in the demonstration schools. W o r k on the detailed design, preparation and pilot work accounted for the first 8 months of the study. A series o f formal and informal discussions was then undertaken to set up and facilitate the fieldwork. The fieldwork with key informants was carried out by
Educationalrespondents (n = 73)
%
Heads of nursingschools Senior nurse tutors Nurse teachers Higher education lecturers
8 68
ENB officers
Total
6
15 3 I O0
Servicerespondents (n = 42)
"%
Chief nursingofficers
6 I0 14 69
Clinicalnursingdirectorates Senior nurse practitioners Ward sisters/chargenurses Total
100
of interviews
The sample consisted of key knowledgeable informants from both the educational sector and the service provider units. A total of 115 respondents was involved, comprising 73 educational staff, about half from each district, and 42 service staff, all but 6 from one district. Table 1 shows the sample characteristics of the key informants. Priority by groups were mainly nurse tutors, college lecturers and senior nurses. A small percentage was made up of heads of nursing schools, chief nursing directorate and officers from the ENB. In essence, perceived problems for nurse teachers at work were examined from two main perspectives: educational and service. Such an approach was considered useful in providing a check on the accuracy of data and a framework for assessing the validity of the evidence obtained from the different parties. This notion was expounded by Diesing (1972), who claimed that the validity of a piece of evidence could only be increased by comparing it with comments of a similar kind or remarks of a similar nature made by different parties. Data
analysis
Data were analysed using a modification of content analysis. All interviews were transcribed by the investigator using models highlighted by Coulthard (1978). The criteria used for the selection o f material for transcription included the relevance to the focus o f the study, the length o f segments on tape and the audibility o f recording. Qualitative data were divided into four broad categories, each with subcategories. The main groups were issues attributed to patterns o f educational organization and management, teaching and learning, administration and professional development.
Issues facing Project 2000 nurse teachers
FINDINGS W h e n asked what they saw as the main obstacles that obstruct nurse tutors in their work, and what aspects of the changes in the role of nurse tutors might be most problematic, respondents gave three main responses to each question. Tables 2 and 3 enumerate the number of responses and not the number of respondents. As illustrated in Tables 2 and 3, analysis of data showed that the main issues identified and the thinking that lies behind them remained more or less the same for the two groups but with a different weighting attached to them. For example, it was noted that professional development issues became more prominent in the light of Project 2000 course implementation. More detailed qualitative analysis o f the data yielded the following insights.
Educational management Responses about educational organization and management issues were mainly concerned with: role ambiguity; poor time management on the part of nurse teachers; ineffective management styles o f heads of nursing schools; too much bureaucracy; inability of nurse tutors to translate the curricular contents into practice; and nurse tutors having to work closely with staff in institutions of higher education on joint course planning and development. Fewer respondents identified poor working relationships and ineffective liaison with the service provider units as major obstacles in the work o f nurse teachers.
205
The most frequently cited reasons for role ambiguity were poor job description and unclear lines of responsibility and accountability. Many nurse teachers claimed that having to work and report to two or more senior managers put them under many pressures. In essence, they argued that different managers had different expectations of their role and therefore made conflicting demands upon them. This may reflect the consequence of a rapid continuing reorganization of nursing schools. U n d e r the heading of poor time management, a n u m b e r of respondents claimed that nurse tutors seemed to be spending too m u c h time on course planning, administration and paperwork, leaving them with little or no time for seeing students in practice areas. Such views seemed to be shared widely by both senior nurse educators and senior nurse practitioners, indicating that perhaps nurse teachers should prioritize their time more effectively. O n the other hand, several nurse teachers claimed that having a heavy workload in terms o f curriculum innovations, and new expectations placed upon them, militated against them spending sufficient time with students in practice settings. Others saw their priorities as having a more pastoral and supportive role to students and their mentors. Comments about ineffective management styles of heads of nursing schools and red tape bureaucracy implied a reluctance on the part of nurse managers to bring about radical changes swiftly. There were also comments regarding attendance at too many meetings with no clear
Issues
Viewpoints Educational respondents, districts A and B (%)
Educational organization and management Professional development Administration Teaching and learning Total
5I 22 19 7 100 (n = 219)
45 27 15 12
48 25 17 l0
I00~= 126)
lO0 ~ = 345)
Educational organization and management Professional development Administration Teaching and learning Total
37 32 17 14 100 (n = 219)
36 28 24 12 100(n = 126)
36 30 20 13 100~ = 345)
Service respondents districts A and B (%)
All respondents (%)
206 NurseEducation Today objectives, and inflexible working hours. As one respondent put it: You heard managers talking about changes but when you offer new suggestions, you get ignored and pushed aside ... Regarding tutors experiencing difficulties in translating the curricular contents into practice, and hence in translating the 'knowledgeable doer' and the 'reflective practitioner' into actual learning experiences, the most frequently cited reasons were inadequate staff development and unfamiliarity with the new document. It was interesting to note that a number o f nurse teachers admitted that they were initially ignorant about what a course outcome at, for example, level 2 should be and h o w such an outcome differed from level 3. As far as joint course planning and development were concerned, a minority o f respondents claimed that such a move could leave nurse tutors feeling like 'a small fish in a large tank', indicating that perhaps several tutors feared being taken over by higher education, an event which they did not see as promising. It must be argued that not all respondents saw the integration o f nurse education into higher education as problematic. Many claimed that it could benefit both nurse teachers and higher education staff: A comment from one staff member was: Maybe the links with higher education would enable both nurse teachers and college lecturers the opportunity to share views and to learn from each other on matters such as course planning and development and for nurse teachers to teach across other departments and have access into higher education. Other interviewees argued that it is essential for nurse education to maintain close links with higher education and the service provider units, otherwise it will distance itself from higher education and the service needs. This suggests the need for nurse teachers to establish effective links with higher education and the service sector for their own survival.
Professional development Key issues identified under the heading o f professional development were: a lack o f opportunities for tutors to undertake further and higher education courses; inability o f some tutors to keep uptodate with the pace o f change and its magnitude; failure o f a significant number o f nurse teachers to develop effectively and implement the nursing curriculum, and to undertake and disseminate research findings. The most frequently cited reasons for failure o f nurse teachers to gain access into higher education
were 'professional barriers' set up by certain individuals, and the 'pecking order' within an organization. Also seen as a major obstacle by several respondents was the lack o f academic skills and clinical credibility o f some nurse educators. O n e said: Teachers o f nurses have often been retro active than pro active; they wait for things to happen and when it happens they stamp on it. It's like a conveyor belt ... Such remarks suggest that there is a need for tutors to b e c o m e more self-assertive and to gain higher academic qualifications with a view to p r o m o t i n g nursing as an academic discipline. Failure o f tutors to translate effectively the curricular contents into practice was linked with lack o f academic skills and staff development. It was interesting to note that a large number o f nurse teachers themselves claimed that they would have liked to have more time and preparation for certain new activities expected o f them. Many mentioned their own lack o f research awareness but were reluctant to comment further about it. Such views were shared by a number o f service respondents: a fact that indicates an urgent need for a majority o f nurse teachers to undertake an intensive staff development programme, and for them to be given adequate support by their superiors.
Administration Administration issues embraced mainly lack o f resources, with a few responses referring to travel and clerical work. The main reasons given were: classroom sizes were too small to accommodate large groups o f 60+ students; little thought went into accommodating large groups o f students on one site; library facilities were poor, as students could not always get the books they wanted; and there were not enough photocopying facilities in the school. A typical comment was: what a waste o f time going up and down the ro ad. Also seen as an administrative issue, though to a much lesser degree, was the fact that tutors were having to compete for scarce resources and to market their courses: developments which many respondents saw as problematic.
Teaching and learning Responses about teaching and learning issues were directed mainly at teaching approaches, assessment o f students' learning and supervision o f students' work, particularly in clinical settings. The factors most frequently cited were a
Issues facing Project 2000 nurse teachers
reluctance on the part of nurse tutors to move away from conventional face-to-face teaching towards an open learning mode of study, for example, computer-assisted learning, and a more student-centred approach to teaching. A significant number of respondents also claimed that a reluctance on the part of many tutors to relinquish teaching a wide range of topic areas or to give up ownership of courses, presented an obstacle to their work. It was interesting to note that several nurse teachers claimed that they would value staff development programmes on alternative teaching and learning approaches. Assessment issues were referred to as poor understanding of devolved continuous assessment of theory and practice, and improper usage of the grading profile by nurse tutors: a fact reflecting a need for continuing staff development. Comments about supervision of students' work included inadequate tutor/student contact time, poor support and supervision of students in practice areas, and tutors increasingly becoming de-skilled: facts that call for increased supervision of students' work in dinical settings and for tutors to move towards specialist work areas.
DISCUSSION
The results indicated that a significant number of nurse teachers experienced obstacles in their work. The main difficulties perceived were failure of a majority of nurse tutors: to move towards a more progressive approach to teaching and learning; to gain adequate support in the pursuit of further and higher education; to prioritize and manage their time effectively; to gain greater academic skills and credibility; and to be more credible in clinical practice. The study also indicated that lack o f adequate resources, such as availability of classrooms of the correct size and the provision of sufficient library books, inhibited many nurse teachers in their work. If we require nurse teachers to change and diversify their work activities as a result o f Project 2000 initiatives, then we need to give them the support they require. This could be best achieved through a comprehensive staff development programme, and opportunities for a greater number of staff to attend further and higher education courses relevant to their preferred areas of interest. The study also highlighted issues relating to educational organization and management, teaching and learning. This indicates the need for senior nurse educationists to be more supportive and flexible in their approach to management, for nurse teachers to be more proactive and adaptable to the change process, and for nurse teachers and
21)7
senior educationists to discuss problems openly. Such facts also call for criticism to be dealt with more constructively and for teachers of nurses to be given the opportunity for individual responsibility, accountability and some degree of autonomy in terms of decision-making. The study also identified issues concerning role expectations and hence the need for nurse teachers to re-examine the work they do. For example, this would include looking closely at their present job description to see whether it is relevant to the role and work they are doing or expected to do in the light o f Project 2000 course implementation. The study suggests a radical review of the nurse teacher's role and job descriptions. Suggestions for a joint teacher-practitioner appointment may be seen as a positive step for a significant number of future nurse teachers to take. This may help to address the issue o f students being inadequately supervised in clinical settings, but the question o f h o w nurse teachers should spend their time and h o w much time should be spent in clinical practice ought to be further explored. The author believes that, if the above are not addressed, someone will soon question the existence of nurse teachers, or at least marginalize them. Administration issues were also perceived as a barrier, suggesting that essential requirements like availability o f proper size classrooms and adequate numbers of library books should be in place in order to atlow tutors to carry out their work in an effective manner. The findings also showed that certain activities, like research, marketing, and supervision of students' work in practice settings, either received a low ranking or were seen as unwelcome developments. There would thus seem to be a need for further research on the preparation required of future nurse teachers. It appears essential that nurse teachers learn to compete for scarce resources and to develop a greater awareness of nursing research, marketing and supervision of students' work in practice settings. The study concludes that barriers in the work of nurse teachers could only act as an inhibiting agent to the change process. As indicated by Towell 8: Harries (1979) and Docking (1980), an educational environment is ripe for change when the following conditions coexist: openness; good interpersonal relationships; effective communications; freedom from organizational constraints; supportive leadership; and trust. In conclusion, in the light of this study, it can be argued that major barriers in the work o f nurse teachers can be dealt with effectively through the following: •
Continuing staff development and academic growth in terms of time management,
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curricular innovations, research, m a r k e t i n g and alternative m o d e s o f study •
A revision o f j o b description for nurse teachers
•
N u r s e teachers learning to prioritize their w o r k and to c o m p e t e for scarce learning resources
•
N u r s e managers b e i n g m o r e supportive and flexible in terms o f educational organization and m a n a g e m e n t
•
N u r s e e d u c a t i o n c o n t i n u i n g to m a i n t a i n effective links w i t h h i g h e r e d u c a t i o n and the service p r o v i d e r units
•
P r o v i s i o n o f adequate learning resources to facilitate nurse teachers to fulfil effectively the role e x p e c t e d o f t h e m .
ACKNOWLEDGEMENTS I would like to thank University of Luton colleagues Dr John Paley and Professor David Berridge for their comments on the manuscript.
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