Transitioning back to faculty roles after being a Robert Wood Johnson Foundation Nurse Faculty Scholar: Challenges and opportunities

Journal Pre-proof Transitioning back to faculty roles after being a Robert Wood Johnson Foundation Nurse Faculty Scholar: Challenges and opportunities

Cindy M. Anderson, Jacquelyn Campbell, Patricia Grady, Maryjoan Ladden, Angela Barron McBride, Nilda Peragallo Montano, Nancy Fugate Woods PII:

S8755-7223(20)30029-6

DOI:

https://doi.org/10.1016/j.profnurs.2020.02.003

Reference:

YJPNU 1299

To appear in:

Journal of Professional Nursing

Received date:

12 August 2019

Revised date:

10 February 2020

Accepted date:

12 February 2020

Please cite this article as: C.M. Anderson, J. Campbell, P. Grady, et al., Transitioning back to faculty roles after being a Robert Wood Johnson Foundation Nurse Faculty Scholar: Challenges and opportunities, Journal of Professional Nursing(2020), https://doi.org/ 10.1016/j.profnurs.2020.02.003

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Journal Pre-proof Transitioning Back to Faculty Roles after being a Robert Wood Johnson Foundation Nurse Faculty Scholar: Challenges and Opportunities Cindy M. Anderson, PhD Martha S. Pitzer Center for Women, Children and Youth College of Nursing The Ohio State University Columbus, OH, U.S. [email protected]

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Jacquelyn Campbell, PhD School of Nursing Johns Hopkins University Baltimore, MD, U.S. [email protected]

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Patricia Grady, PhD Director Emeritus National Institute of Nursing Research, NIH Bethesda, MD, U.S. [email protected]

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Maryjoan Ladden PhD Robert Wood Johnson Foundation 50 College Road East Princeton, NJ, U.S. [email protected] Angela Barron McBride, PhD School of Nursing Indiana University Indianapolis, IN, U.S. [email protected]

Nilda (Nena) Peragallo Montano, PhD School of Nursing University of North Carolina 107 Carrington Hall, CB #7460 Chapel Hill, NC, U.S. [email protected] Nancy Fugate Woods, PhD School of Nursing University of Washington

Journal Pre-proof Seattle, WA, U.S. [email protected]

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Corresponding author: Cindy M. Anderson 614-292-4179 [email protected] 1585 Neil Avenue 346 Newton Hall College of Nursing The Ohio State University Columbus, OH 43210

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Abstract Background: There is a dearth of literature describing factors supporting a successful transition from a career-development fellowship to resumption of the full complement of faculty roles. Purpose: Because little is known about the transition back to the full faculty role, a subset of Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars (NFS) was interviewed to evaluate the self-identified challenges and opportunities that the scholars faced and factors

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contributing to their success when they reassumed the full faculty role. Methods: A subset of scholars from cohorts beginning the RWJF NFS program between 2008-

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2012 (n=10) was interviewed by members of the NFS National Advisory Committee. NFSs

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identified challenges and opportunities faced as they transitioned to their faculty roles following completion of the career development fellowship as well as the character of support

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received from individuals in their organizational influencing the experience of the faculty

institutions, colleagues and fellows.

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transition. Evaluation outcomes include recommendations for transition planning for home

Results: NFSs identified transition challenges including managing multiple responsibilities and

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increased teaching demands coupled with loss of protected time and funding for scholarly

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work. Opportunities for career advancement were influenced by effective mentorship, institutional supports including advocacy and allocation of time and responsibilities consistent

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with continued research productivity. Issues contributing to a more difficult transition included non-supportive relationships among administrators and colleagues and newly assigned responsibilities that detracted from success in meeting expectations for tenure and promotion. Effective transition from fellow to faculty included plans for continued mentorship and stakeholder engagement of administration, mentors and faculty colleagues. Conclusions: Effective transition from fellow to the full complement of the faculty role benefits both the home institution and scholar. Positive outcomes may be contingent on scholar support and organizational investment during the transition period.

Key words: career development, academic transition, mentorship, scholarship

Journal Pre-proof Introduction The conduct of high quality research by nurse scientists is needed to advance science and improve lives (National Institute of Nursing Research, 2016). The declining recruitment of students to PhD programs (Fang, Li, Turinetti & Trautman, 2019, p. 8) coupled with the demands of establishing and sustaining a career as a nurse scientist (Kinser, Loerzel, Matthews & Rice, 2019) represent significant threats to the retention of research-focused faculty in academic settings. Career development fellowships provide a mechanism by which junior

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nurse scientists receive the mentorship and protected time to establish their research trajectory with the anticipated outcome of sustaining a successful program of research across

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their careers. The Robert Wood Johnson Foundation (RWJF) created the Nurse Faculty Scholar

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(NFS) program to address the nurse faculty shortage through establishment of a career development program with a goal to prepare the next generation national leaders in academic

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nursing (Campbell et al., 2017). Employing a multipronged approach, scholars engaged in leadership development, enhancement of nursing education skills, focused programs of

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research and scholarship and service through engagement in institutional, university, and professional governance systems (Anderson & Amar, 2017). An established mentor network

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designed to support the scholar in research and professional development, locally and

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nationally, was another key feature of the program (McBride, Campbell & Deming, 2019). Outcomes of those engaged in career development fellowships are typically limited to

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reports of research and clinical productivity or job and/or career transitions following fellowship (Mehta & Forde, 2013; LaCasce, Graff, Gau, Close & Boulmay, 2019; Porter-O’Grady & Malloch, 2017; Runyan, Austen & Gildenblatt, 2017; Saha, Saint, Christakis, Simon & Fihn, 1999; Taylor, Broyhill, Burris & Wilcox, 2017). The full complement of the faculty role in academic nursing extends beyond research productivity, with additional responsibilities of teaching, service and administration which, if not managed effectively, can pose a challenge to successful transition and may limit establishment and sustenance of a productive research career. Little is known about the transition experience of scholars who return to the full faculty roles after completing research career development fellowships. This study was completed as part of an overall evaluation of the NFS program. A subset of Robert Wood Johnson Foundation

Journal Pre-proof (RWJF) Nurse Faculty Scholars (NFS) was interviewed to determine the self-identified challenges and opportunities that the scholars faced and factors contributing to their success when they reassumed the full faculty role. Evaluation outcomes include identifying approaches to support successful transitions from career development fellowship to the full complement of faculty roles among RWJF NFSs, informing recommendations for transition planning for home institutions, colleagues and fellows. Review of the Literature

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Transition Theory Transition theory provides useful frameworks for analyzing dimensions of transitions

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from the roles of career development fellows to university faculty. Meleis and colleagues

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(2010) delineated multiple properties of such transitions, including changes in identity, roles, relationships, abilities, and patterns of behavior, among others. Conditions surrounding the

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transition can facilitate or inhibit successful outcomes of the transition that span well-being, mastery, relationships, and self-management capacity. Transition conditions include meanings

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attached to the transition, as well as expectations, levels of knowledge/skills, environment, and level of planning, among others. Indeed, this organizational transition may occur in the midst

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of other developmental transitions, for example, deciding whether to take advantage of

professor.

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another job opportunity or putting together a promotions portfolio from assistant to associate

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Transition from fellow to full faculty requires a re-envisioning of identity, roles, relationships and abilities that, when taken together, can determine longevity in the institution and in a career as a nurse scientist. While there is an absence of published findings regarding aspects of nurse faculty roles after fellowship transition, findings across other disciplines illustrate a pattern of opportunities and barriers that influence career trajectory.

Career Development and Research Transition Participation in career development awards has demonstrated outcomes related to productivity and professional development, although there is some evidence that health professionals receiving career development awards experience challenges as they transition

Journal Pre-proof back to faculty roles. Outcomes reporting success in securing research grants and publications among physician scientist fellows receiving National Institutes of Health (NIH) mentored career development awards provide evidence for the positive influence on outcomes significant to the scientific enterprise (Mason et al., 2013). Among recipients of NIH career development awards, a large majority remained active in academic medicine (89.6%) and of those, 75% remained engaged in research approximately 10 years after fellowship (Jagsi et al., 2011), illustrating significant return on investment for organizations and individuals.

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Recent evaluations of transition outcomes from NIH career development awards indicate that fellows experience challenges as they transition. Preparation of fellows may

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support them as they encounter new expectations of themselves, relationships with peers and

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organizational accountability. Factors to consider include individual fit with new role, shifting relationships with colleagues and organizational climate. Krag and Thiele (2016) describe the

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unique challenges of adapting both personal and professional identity. While returning faculty may not see themselves as having personally changed, colleagues may feel differently. Faculty

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may return with increased self-confidence and a clearer vision of what success means to them. However these qualities may be interpreted by colleagues as arrogance and a sense of

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entitlement. Professionally, returning faculty can be overwhelmed with the loss of protected

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time and responsibilities for increased teaching, student mentoring, and administration. Shea and colleagues (2011) identified a variety of factors influencing the success of clinical

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researcher transition including their feelings of responsibility for their roles in department/division administration, responsibility for contributing to clinical care, collegiality of mentoring relationships, adequacy of research equipment, and departmental climate. Burn out among physician scientists supported by NIH career development awards in the prior 5-8 years was reported by Perumalswami et al. (2019), pointing to negative perceived work climate in the academic medical environment. Factors contributing to burn out included substantial competing demands (at home and work) and early-career perceptions of work climate, particularly among women. Gender-based variability in career progression were also reported including lower likelihood of promotion, advancement for leadership roles, R01 funding application submission and fewer publications among females after career development

Journal Pre-proof programs compared to their male counterparts (Jagsi et al., 2011). Taken together, individual and organizational factors exert significant influence on the career trajectory of health care providers in the academic practice setting and serve as a template for which to evaluate career progression of faculty in the academic setting. Beyond research effectiveness, faculty experiences after returning to the full complement of faculty roles following career development awards have not been examined. Here we contribute to the literature with evaluation of individual and organizational factors

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that support or hinder successful transitions from career development fellowship to the full complement of faculty roles among RWJF NFSs. Findings will inform recommendations for

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transition planning for career development programs, scholars and home institutions including

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identifying approaches to support successful transitions from career development fellowship to the full complement of faculty roles among RWJF NFSs informing recommendations for

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transition planning for home institutions, colleagues and fellows that may be applied to similar

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programs.

Materials and Methods

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Sample

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This program evaluation was approved under the evaluation plan for the RWJF NFS program by the Johns Hopkins University IRB. A total of 93 scholars entered the RWJF Nurse

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Faculty Scholars fellowship program between 2008-2014 entering the fellowship between 2008 and 2012 (n=10) was contacted by email, selected based on cohort, gender, race, region of the country, and university type in order to tap diversity in experience. Procedure All invited participated in telephone interviews conducted by members of the program’s National Advisory Committee (NAC) regarding their experiences returning to the faculty role. Scholars were accustomed to being interviewed about their experience by NAC members during the course of their fellowship, accounting for the response. Members of each cohort from 2008-2012 were interviewed by phone during 2018. Interviews were scheduled 3-7 years after scholars had transitioned from their 3 year fellowship back to their academic

Journal Pre-proof appointments. Scholars were sent a transcript of their individual responses for their verification and were edited as necessary. Interview questions (Appendix 1) addressed challenges and opportunities the scholars faced as they transitioned to their faculty roles, supports most important during the transition, individuals who helped with the transition, factors that made the transition difficult, individuals who made the transition difficult. We also elicited scholars’ recommendations for how this transition might be improved, including institutional support and support from individuals. We encouraged scholars to reflect on what

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would have been helpful to them to prepare for the transition and to offer advice about preparing others for the transition in the future. Interviews were planned for one hour in

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length. Participants’ willingness to schedule and complete a telephone interview provided

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evidence of their consent to participate. Saturation of categories guided the final number of interviews conducted.

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Narrative data were obtained and written summaries were coded and themes extracted by the collective of authors using summative content analysis to identify themes and

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participants’ experiences (Hsieh and Shannon 2005). Content analysis began with identifying words or phrases in the text in order to understand their contextual use. Some categories

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identified prior to analyses were included in the interview questions (Appendix 1). Manifest

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content analysis guided our approach to analyzing the data. Each author reviewed each

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transcript, identified themes, validated themes, and reviewed multiple drafts of the manuscript. Results

All participants remained in faculty roles with many also assuming leadership positions in academic nursing. Characteristics of participants are described in Table 1. Challenges and Opportunities Participants identified both the challenges and opportunities they experienced during their transition to their faculty roles from the RWJF NFS fellowship and the supports and barriers they encountered during their transitions (See Figure 1). These are described below. Managing Multiple responsibilities and loss of protected time. The most commonly reported challenge for NFS transitions focused on managing multiple responsibilities in relation to the loss of protected time for scholarly work/research. Meeting increased teaching

Journal Pre-proof expectations, providing leadership or assuming administrative responsibilities, managing conflicting expectations, finding new resources for advancing one’s career, and engaging with mentors contributed to the central challenge of managing multiple responsibilities. (See Figure 1 – Transition Experience). For several scholars loss of the research funding at the end of the NFS program intensified the need to seek additional grant support. Although scholars had been encouraged to obtain additional research funding by the end of their fellowship in order to cushion the transition, many were not able do that for a host of reasons. For example,

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encountering problems recruiting the sample size planned in the NFS proposed research project delayed analysis and publication. Additional responsibilities of teaching and service, coupled

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with loss of protected time, resulted in challenges with grant writing, limiting time to submit R

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series proposals.

Important to most scholars was having access to protected time for research, as well as

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other efforts. Although this was available to some scholars, it was not universal. Some NFS felt they needed to “pay back” the time they had available during the RWJ NFS program by

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assuming extra responsibilities when the program ended. Others who had obtained additional research funding prior to completing the NFS program experienced a seamless transition in

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funding. Nonetheless, most expressed needing continuing mentorship in their research, such

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as with starting up a newly funded project within their university. Another NFS reported on having some time re-allocated from teaching to directing a program, strengthening the NFS’s

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skill in administration. This, in turn, increased the scholar’s flexibility to engage in scholarly work, such as preparing research proposals. Making multiple transitions was mentioned by several scholars, including one who made a transition to a new university at the same time as completing the NFS program. Newness to another school made it difficult to find mentorship for NIH grant proposal preparation. Another scholar made the transition from the NFS program simultaneously with promotion review, prompting her to reflect on her career trajectory, asking herself “what now”? Her reflection ultimately led her to seek a position at another university. One scholar described the transition experience as more flow than transition, characterizing the experience as “not a stark transition.” Progression from junior to senior

Journal Pre-proof faculty occurred quickly for this individual, prompted by faculty retirements that created heavy responsibility such as chairing doctoral committees. This scholar remarked that her experiences created opportunity to do some innovative things. She recalled thinking that “Someone should do something” … “then realized it (the someone) is you!”. In contrast, another scholar reported feeling like a “senior in high school, anticipating what to do next. Not a real bridge … abrupt change. Driving along and going off the bridge!” This scholar did not feel confident about making the transition, including taking on some leadership opportunities.

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Some NFSs reflected on being a minority in their school (e.g. gender or race) and consequences for their transition. In one instance, an NFS was asked to assume

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disproportionate responsibility for mentoring minority students and serving on committees or

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leading diversity efforts, although this did not count toward promotion and tenure. In another instance, one NFS was advised that their minority status accorded them privileged status and as

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a result they should not be considered for internal funding for initiatives. In addition, one NFS’s efforts were dismissed based on minority status. In one case, the NFS mentor was helpful in

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exploring equity issues.

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Meeting increased teaching expectations. Not only did the number of courses the

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scholar was expected to teach increase (e.g. from one to three per semester), the nature of teaching became more demanding. Examples included teaching doctoral students and

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mentoring doctoral student research. Additionally, many NFSs were tasked with developing new courses and curricula. For most, the increased teaching demands coincided with opportunities to continue to develop scholarly work, often at critical junctures, such as developing R series proposals for submission to NIH. One scholar reported she had not experienced much of a change in teaching as she had not experienced much of a reduction in her teaching load during the NFS program, contrary to program expectations. Her heavy teaching requirement was the result of her teaching a course during the NFS fellowship that could not be easily reassigned to another faculty member based necessary content expertise.

Journal Pre-proof Providing leadership. Scholars were invited to assume leadership responsibilities, either during the NFS or shortly after completion. Although some found this challenging, others noted that that the service to the school was essential. These additional responsibilities led one scholar to comment on the need to “learn on the fly”. Being asked to take on administrative responsibilities, such as serving as an assistant dean or program director with supervisory responsibilities for programs and faculty, was not unusual for the NFSs despite most not yet having been promoted to associate professor and/or awarded tenure. Although

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these opportunities provided NFS with additional academic leadership experiences, they also created time pressures that competed with their ability to pursue research. Some NFS

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acknowledged they were a logical choice for these positions and were prepared for the

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leadership role, but challenged simultaneously to move their research agendas ahead.

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Managing Conflicting Role Expectations. Managing conflicting expectations was clearly a challenge for most of the scholars, as they faced competing demands for their time.

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Conflicting expectations arose from the need for them to perform multiple roles (teaching, research, university and community service, curriculum and course development). As they

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prepared for promotion reviews, some scholars mentioned changing expectations of them.

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Others found that reconciling conflicting expectations was a challenge requiring relationship navigation, as exemplified by managing contrasting recommendations about scholarly products

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made by senior colleagues.

Some NFS reported experiencing changing expectations. One described having accomplished something, only to be told that the scholar needed to do something more couched as an unwritten expectation. While preparing for promotion, this scholar experienced being told of new requirements each time the last was met while other faculty seemed to achieve promotion without meeting these additional expectations. Finding New Resources. Finding new resources to replace those provided by the career development fellowship also constituted challenges for some and opportunities for others. One NFS described having RWJF funds replaced by support from another source. The RWJF funding allowed her to develop herself as a scholar as she developed her research team. After

Journal Pre-proof her transition to full faculty roles, she concentrated on building her research team as well as her area of research in her university, crediting the RWJF NFS for positioning her for future research. Scholars also reported the value of receiving guidance from resource people on the campus at large and beyond the university. One NFS worked with curriculum experts from across the campus to develop a new program. Others networked with investigators from other parts of the university to enrich their research. Yet another commented on the service on

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boards in the larger university as helpful in developing additional administrative skills. Scholars also identified the value of supportive staff as providing important assistance and advice on

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administering programs. Often these individuals had the “know how” to make things happen in

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the institution that the NFS lacked.

External recognition of the skills gained by the NFSs led to new opportunities on their

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campuses. Opportunities for advancing one’s career arose when scholars were able to engage in activities outsides of their own colleges or schools. Becoming involved in various service

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opportunities on campus and linking to new groups interested in similar topics led to identification of research collaborators for some. One NFS described being asked to develop an

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undergraduate honors program that allowed her to incorporate elements of the NFS

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experience, such as leadership development and engagement of students with mentors outside

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of the School of Nursing.

Engaging with Mentors. Some scholars emphasized the opportunity for connecting with mentors from NFS after completing the program, continuing to benefit from their mentorship. One NFS described her transition from NFS to funding by the Josiah Macy Faculty Scholars Program as seamless, establishing a positive relationship with her mentor for the Macy program during the RWJF NFS program. In contrast, another scholar was uncertain about how to use the mentoring team both during and after the NFS program, and did not have access to a mentoring team during the transition. Some scholars described searching for new mentors on their campuses and the need for formal mentoring in their schools. NFS national mentors and research mentors also continued to contribute to faculty development. One NFS reported that

Journal Pre-proof an invitation by their national mentor to international organization meetings had broadened the scholar’s professional networks. For several NFSs, mentorship needs were related to professional issues as much as research. Many scholars commented that they continued to interact frequently with peers in their NFS cohort as well as those in earlier and later cohorts. Peer mentorship across NFS cohorts provided honest and helpful feedback founded on early trust-building experiences in the program. NFS peers were helpful in describing ways of doing things in other institutions, providing helpful baseline for measuring their own expectations.

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Opportunities to connect with NFS peers remained a supportive opportunity for many.

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Supports for the Transition

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Mentorship. Most scholars described receiving mentoring, including feedback from the National Advisory Committee (NAC) members and mentors at each meeting during and after

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the NFS program. Mentors (primary, research, and national mentors), NAC members, staff, and peer NFSs supported scholars by providing honest feedback. A primary mentor from the home

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institution continued to work with one NFS after they transitioned back to their faculty roles, meeting less frequently, but providing mentorship about issues in the workplace (e.g. issues to

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confront, personalities to manage, and workplace troubles to address, incorporating NFS

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leadership within faculty roles). NFS mentors were helpful in providing career advice, including next career efforts and what might help the NFS’s career trajectory. One NFS had a primary

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mentor who was a full professor with several R01s in her portfolio who advocated in various areas of the scholar’s work, such as getting an adjusted course load to allow the NFS to focus on R grant submission.

Colleague and Administrative Support. Many scholars reported receiving support from faculty and peers in the scholar’s own university. For some, colleagues who were at a similar rank provided support when more senior faculty did not. In other institutions, senior faculty and administrators provided mentoring as part of their roles and responsibilities. One scholar reflected on receiving guidance through sticky situations (e.g. reconciling mixed advice, responding to pressure to accept a difficult position as committee co-chair). She was able to work with senior mentors in her school to help meet the challenges, navigating relationships in

Journal Pre-proof the school and “taking the high road.” For one NFS who had more experience in non-academic environments, becoming accustomed to the culture of the academic environment (e.g. the influence of faculty rank) was challenging. She leveraged “protection” conferred as an assistant professor which allowed her to decline some opportunities for which she was not yet ready. Support from deans and other administrators was reported as varied. One scholar described receiving support from a dean who had written the scholar’s nomination to the NFS, but who was no longer in the role after the scholar transitioned out of RWJF NFS. The dean’s

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successor ”minimized the value” of the NFS award. This NFS ultimately transitioned to a larger research-intensive university where rapid change was occurring and where the leadership team

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was challenged to make difficult decisions. In this new environment, she was able to

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incorporate many of the skills and knowledge learned in the NFS program and was provided with additional leadership training. She commented that RWJF NFS program prepared her to

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lead a diverse group of faculty who were “not all on the same page” with the vision of the school. The tools developed in the RWJF NFS program, including budget management and

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leadership training, were extremely helpful.

Research Support Services. NFSs who were able to access research support services as

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well as intramural funding from their school or the campus at large indicated the important

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impact on their continuing career development. For some, having a modified assignment that included support for a percent of the time allocated to research development enabled them to

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continue developing their scholarly work. Some scholars reported having research support services as important. One NFS described being in a school with a strong research enterprise in which support from staff and infrastructure allowed her to generate proposals, develop budgets, and obtain reviews from colleagues. Faculty provided helpful advice for grant proposal submission, as did the department chair and vice chair for research in her department. Being supported in generating new research support was especially valuable in building the research program the NFS had initiated with the RWJF support. Advocacy. Some scholars reflected on colleagues who had advocated for their work as well as their research partners who supported their work. For one NFS, professional contacts in

Journal Pre-proof other schools on campus were most supportive in this work as there was a lack of research mentoring in her school of nursing. For this scholar, the greatest support came from a faculty member from another school in the university who helped develop contacts supporting NFS’s research. Another NFS reported having support from a great team on a research project, including a more senior individual helping with writing, critiques and support to get things off the ground. Another NFS cited having a research partner with whom to communicate openly. This individual ultimately assumed the role of associate dean for research at the NFS’s school.

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Barriers to Transitions Competition and Lack of Shared Goals. Some NFSs encountered colleagues who were

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resentful about not having had the RWJ NFS opportunities themselves. Senior faculty at one

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scholar’s university exhibited resentment toward her when she obtained research funding and published papers. She felt resented for “raising the bar”. On the other hand, faculty in this

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scholar’s same rank were collegial and supported one another. When one NFS attempted to engage with clinical faculty in advancing clinical scholarship, senior faculty did not participate in

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the research activity or leverage activities with students. In some schools, colleagues were not oriented to the research roles of faculty and did not have experience with NIH funding. In this

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instance, the research climate in the school coupled with the absence of NIH funding and

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limited NINR funding available, led the scholar to try to broaden the research question to fit with other funding agencies.

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Some NSF experienced colleagues who could not embrace the NFS’s research interests. One found that no one was unhelpful, but just not helpful. Colleagues were more apt to focus on other needs of the organization rather than the NFS’s developmental needs related to scholarship. For example, some NFSs had challenges related to the institutional mission/values of a school in which teaching was the primary orientation, rather than the combined teaching and research orientation which the scholar anticipated. Another NFS reflected on being seen as a bit of an outlier with respect to research interests. The school wanted the NFS to be part of center award, but the scholar wanted to apply for a K or R21 funding to garner additional needed research mentoring and opportunities. Pressed to go in a different direction than desired, this scholar eventually transitioned to a new school.

Journal Pre-proof Research support provided time for pursuing funded studies, but in some instances the time was committed to administering others’ projects. Although these experiences were interesting and provided enjoyable camaraderie, they did not advance the scholar’s personal research. Conflicting and Shifting Expectations. Mentioned earlier, lack of consistent and clear expectations led some scholars to feel uncertain about their performance and career paths. In some instances scholars were uncertain about who had the authority to generate and/or

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change expectations of them. Lack of Transition Planning. NFSs experienced the consequences of lack of transition

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planning, resulting in unclear expectations on the part of colleagues and scholar’s uncertainty

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about their own career path. One NFS encountered mentors from inside their school pressuring the NFS to assume responsibilities for which they felt unready. Advice from mentors

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from outside the organization and other long-standing mentors provided support for NFS, reinforcing strategic approaches to manage the situation. Another NFS encountered program

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directors who did not embrace the tripartite mission, allocating heavy teaching loads without consideration of the NSF’s other responsibilities. One NSF encountered too many

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opportunities, reflecting on the need to sort them out, find her path, and stay true to who she

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was. Prioritizing was important because of her excitement about where she was in her career. Most people she sought to work with were outstanding, but when signs of difficulty appeared

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in the relationship, she tried to modify it.

Recommendations for Preparing Scholars for Transition from Career Development Awards to Faculty Roles NFSs offered recommendations for preparing scholars for transitions from career development awards to faculty roles, based on their recent experiences. Among these were recommendations directed to the NFS Program, their home university/schools, colleagues, and for other NFSs as they make transitions from career development programs to the full complement of faculty roles (see Box 1).

Journal Pre-proof Scholars made several recommendations for future scholars during the program including offering to share what they were learning with others in their home schools so that their colleagues could also benefit from the program indirectly. Some achieved this through informal meetings or seminars or by integrating this information in regularly scheduled meetings of the faculty. Scholars also recommended being planful about the purpose of the award and their own long term goals, for example, by asking themselves: Is it research development or faculty development? Some recommended learning how to resolve

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challenges, allowing other scholars to communicate about their learning, including how they give back to their institution.

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Recommendations related to mentorship relationships included working with one’s

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primary mentor to identify projects to close out before starting the career development award so the work on the career development project could proceed on time. Some emphasized

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getting grant funding prior to the end of the career development award and publishing results of the funded project before the end of the award. Some recommended using time during the

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NFS program to publish more papers and submit multiple R grants. Scholars made specific recommendations for future scholars for the year prior to the transition

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and 2, respectively.

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and the first few years after their transition to their faculty roles. These are included in Boxes 1

Recommendations for the home institution included preparing colleagues to

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understand what the NFS can contribute to the organization. This orientation should enhance the institutional leadership’s and colleagues’ ability to engage the scholar in ways that allow the institution to benefit from the NFS (or other) career development program. In addition, scholars indicated that they continued to need coaching in their institutions, helping them bridge to their new roles. Mentors in the home institution need preparation about transition planning to help their fellows anticipate what is coming next and to provide anticipatory guidance about the transition. Scholars also recommended encouraging them and their colleagues to take opportunities to pause and reflect on next steps in their career over a lifetime.

Journal Pre-proof In addition, scholars indicated they needed mentoring to continue over the first year of the transition if not longer. Some recommended that the institution should provide assigned mentoring responsibility for the transition period. Indeed, having a formalized mentoring plan/program for junior faculty with teaching, research, and career development mentors was strongly recommended. In addition, home universities could support professional coaching to facilitate the transition. Recommendations for career development programs, such as the RWJF NFS included

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planning for the transition as a formal part of the program. Planning for the transition by facilitating focused discussions on the challenges scholars are likely to experience, e.g.

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assumptions by colleagues about scholars’ privilege as a result of their funding when no one

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else in the school has had this kind of support, was recommended as a means of helping scholars envision some of the challenges they would encounter and anticipate how to prevent

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or manage them. Although some scholars had offered to discuss their learning as NFSs with colleagues, this was not universally incorporated as a strategy. For some, this dialog was

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helpful in re-integrating into their roles.

Incorporating transition planning in an individualized development plan (IDP), linking

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criteria for promotion and tenure at the home university, was recommended to facilitate career

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transition. NFSs commented that formal attention to an individualized plan may have helped with negotiating a transition plan with the home school that would allow them to meet the

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needs of the school while continuing to meet their personal development goals. Recommended discussions included focusing on the deliverables of success, e.g. funded grants, scholarly products, teaching achievements valued by the NFS’s institution and how to increase productivity during the career development program with an eye toward increasing expectations after transitioning to the complement of faculty roles. Scholars also recommended talking with mentors about next steps to anticipate after the NFS program was completed. They emphasized the need to discuss how to pursue their personal career development along with the schools’ activities. Insuring that mentors were aware of how to use the IDP in their mentorship discussions with the NFS was also recommended as a program element.

Journal Pre-proof Finally, scholars recommended that the program include more formally scheduled time for the support network of the NFS cohort to engage during the latter part of the program and to re-engage as alumni. They emphasized that programs should continue to support engagement of alumni, indirectly allowing them to contribute to many institutions through the alumni network.

Conclusions

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Participants in the RWJF NFS program were performing a full complement of faculty roles prior to beginning the fellowship. The transition from career-development fellowship -

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having protected time for research and scholarly activities - back to the full complement of

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roles (e.g. teaching, research, service, administration) can be fraught with both personal and professional challenges. The challenges and opportunities associated with the RWJ NFS’s return

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to the full complement of faculty roles in the home institution were shaped by the combined influences of the responsibilities and priorities of the institution, transition from being the

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mentee to the mentor, allocation of resources to support research and career development, and redefined relationships. The research support combined with the richness of mentorship,

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leadership and teaching development uniquely prepares NFSs for the full complement of

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faculty roles in contrast to other individual mentored career development awards that focus solely on transition to independent research careers (Nikaj & Lund, 2019). Mentors with

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experience navigating the transition process may prove beneficial from an organizational and individual perspective. The experience of receiving effective mentorship benefits both mentor and their future mentees, extending the future commitment and willingness to “pay it forward” to others (McBride, Campbell & Deming, 2019). To date, evaluation of transitions from mentored career development programs to faculty roles has focused nearly exclusively on research–related outcomes. The application of strategies that ease transition from fellow to faculty have application across disciplines. The increasing need for nurse scientists may be countered by reduced numbers of students entering PhD programs and the aging of current faculty (Physician Scientist Workgroup, 2014), similar to challenges of physician scientists. The challenges of multiple demands have potential

Journal Pre-proof to lead to burnout, much like that experienced by physician-scientists. Management of the work environment to reduce barriers related to conflicting commitments in establishing and sustaining research-focused careers in academic nursing has relevance for nurse scientist longevity, particularly in light of the unique challenges among women faculty. Understanding the challenges and opportunities fellows experience as they embrace the full complement of faculty roles following an early career development fellowship remains for future investigators. In Figure 1 we propose a framework for understanding the experiences and outcomes of

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career development programs such as the RWJ NFS program. The Transition Experiences include both challenges and opportunities, modified by transition supports and transition

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barriers. In turn, the transition experiences lead to transition outcomes related to the scholar’s

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development, colleagues’ development, and the home institutions’ future. Although fellows gained attributes suited to a career in academia, the acceleration of delegated responsibilities

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of junior faculty NFSs positioned them for roles which they were not fully prepared to assume nor reasonably able to decline at their relatively early career stage. Examples from NFS

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participants citing the institutions’ expectations of high teaching loads, mentorship of doctoral students, leadership on committees and administrative positions reflect the potentially

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premature advancement opportunities that may have created barriers for research

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development and advancement. Dissatisfaction for some scholars led to subsequent transitions to a new institution, precluding the school’s return on investment in the NFS.

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Reflecting on their recent experiences of transitioning from a career development award to the fullness of faculty roles, NFSs identified multiple challenges and opportunities, as well as activities and people who supported or did not support their transitions. Some scholars were challenged by mismatches between the expectations they had developed for their careers in academic institutions and the actual expectations of the institutions. Although the career development program had emphasized the fullness of faculty roles (teaching, research, service), scholars often found that organizational expectations did not align well with their own expectations, such as having opportunities to continue building a research program. Managing multiple and sometimes conflicting expectations while finding new resources to advance one’s career goals was common among the NFSs experiences.

Journal Pre-proof Supports for NFSs transitions included; mentoring from the NFS program, faculty and peers in the home school/institution; research support including time and institutional funding and staff to support conducting research and developing grant proposals; and advocacy and guidance from resource people across the campus. Transition barriers included nonsupportive experiences with colleagues who were not oriented to research as a career goal and those who resented not having the career development opportunity, themselves. In addition, experiencing pressure from colleagues and leaders to assume roles for which the NFS did not

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feel prepared, needing to sort opportunities in order to focus, being regarded/treated as a minority, and experiencing confusing communication about changing and conflicting

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expectations to the NFS after the transition constituted additional barriers.

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Scholars provided recommendations for the career development program, themselves, and their home institutions spanning specific time frames, beginning with the career

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development program and extending 3 to 5 years after transitioning back to their home institutions. Overarching recommendations of the NFS focused on planning for the transition

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to the faculty roles in the home institution as early as possible during the career development award and continuing throughout the first 3-5 years after transitioning to faculty roles in the

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home institution. Scholars emphasized the importance of mentorship from the career

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development fellowship (those both internal and external to their schools) in helping them discern the expectations of the home institution and including these, such as benchmarks for

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promotion and tenure, in their individual development plans. In addition, they emphasized the importance of maintaining the IDP as a career-long discipline, especially throughout their first 3-5 years after transitioning to their institutions. Deans and directors of nursing programs cited benefits of NFS participation as acceleration of scholars’ leadership, scholarship, influence and school research profile (McBride et al., 2017), demonstrating benefit to the home institution and the individual scholar. Scholars strongly emphasized the importance of communicating with the administrators in their home institutions in anticipation of their transitions, including them in discussion of a transition plan in their IDP. Likewise, discussing the transition plan could afford opportunity for negotiations shaping expectations for the transition. Administrators, such as deans or department chairs,

Journal Pre-proof could actively engage with the scholars in preparing the environment for their successful transitions. Moreover, leaders within the home school could support scholars by interpreting their potential contributions to the institution to colleagues, thus supporting scholars in integrating their new knowledge and skills to benefit the home institution, colleagues and students. The career development program could also contribute to helping leaders of the home institution imagine how to benefit from the scholar’s unique contributions, affording them opportunity to prepare their faculty for a supportive transition. By clarifying

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expectations of the scholar and who is authorized to articulate them for the school, and reducing conflicting and unrealistic expectations on the part of the NFS, faculty colleagues and

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administration would enhance the scholar’s transition experience.

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Mentorship, an essential component of the NFS program, provides the benefit of support and advocacy, although the relationship may be challenged by issues of mentor

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accessibility and match (McBride, Campbell, Woods & Manson, 2017). Continuity of mentorship relationships was supportive for several of the NFSs as they transitioned to their home schools.

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As scholars transitioned from having mentors to also becoming mentors, their needs for mentorship changed to accommodate these changing expectations. Scholars emphasized the

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value of mentors helping them anticipate some of the challenges they would face during their

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transitions and recommended opportunities for transition debriefing with administrators (e.g. dean or department chair) as part of the career development award, following completion of

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the formal program. This could include clarifying the expectations of the scholar’s contributions to their school vs the university as a whole. The transition experience from fellow to faculty roles aligns with changes in identify, roles, relationships, abilities and patterns of behavior, consistent with elements of transition theory (Meleis et al., 2010). The influence of the fellows’ expectations, colleague and mentor relationships and institutional expectations and culture all contribute to the ease of transition to faculty roles and subsequent career progression. Disparate perceptions and expectations often underlie difficulties in transition while approaches to transition that support the NFS also benefit the institution, promoting the benefit of the NFS’s investment into the future. Outcomes of transitions from career development fellowships to faculty roles extend beyond

Journal Pre-proof the individual scholar’s development. Indeed, the RWJ NFS evaluation considered colleague development and home institution benefits (See Figure 1). Recommendations that facilitate NFS transition and promote productivity in faculty roles benefit scholars, colleagues, and home institutions. Such approaches have the potential for exponential benefit, enhancing satisfaction, productivity and culture for both faculty and institutions. In an era of nursing faculty shortages, positive transition experiences can contribute to the retention of NFSs and those completing other early career development

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programs. Evaluation of the transition experiences of RWJ NFSs represents an early effort to understand the experiences of career development fellows as a basis for promoting successful

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transitions for future scholars, their colleagues, and their institutions.

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Acknowledgements

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This study was conducted under the overall support of the Robert Wood Johnson Foundation for evaluation of the Nurse Faculty Scholars program. References

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Anderson CM Amar AF. (May-June 2017). Commentary on "Overview of the Robert Wood Johnson Foundation Nurse Faculty Scholars Program" by Campbell J, Ladden MJ, McBride AB, Cimino A, Kostas-Polston, E & Deming K. Nursing Outlook, 65(3), 265-266 http://dx.doi.org/10.1016/j.outlook.2017.01.002

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Campbell, J., Ladden, M.D., McBride, A.B., Cimino, A., Kostas-Polston, E., & Deming, K. (2017). Overview of the Robert Wood Johnson Foundation Nurse Faculty Scholars Program. Nursing Outlook, 65(3), 254-264. doi: 10.1016/j.outlook.2016.12.008 Fang, D., Li, Y., Turinetti, M.D., & Trautman, D.E. (2019). 2018-2019 Enrollment and graduations in baccalaureate and graduate programs in nursing. American Association of Colleges of Nursing: Washington DC. Gillespie, G.L., Gakumo, C.A., Von Ah, D., Pesut, D.J., Gonzalez-Guarda, R.M., & Thomas, T. (2018). A summative evaluation of productivity and accomplishments of Robert Wood Johnson Foundation Nurse Faculty Scholars Program participants. Journal of Professional Nursing, 34(4), 289-295. doi: 10.1016/j.profnurs.2017.11.001 Hsieh H-F, Shannon S. (2005) Three approaches to qualitative content analysis. Qualitative Health Research. 15(9):1277-88.

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Jagsi, R., DeCastro, R., Griffith, K.A., Rangarajan, S., Churchill, C., Stewart, A., & Ubel, P.A. (2011). Similarities and differences in the career trajectories of male and female career development award recipients. Academic Medicine, 86, 1415-1421. Jagsi, R, Griffith, KA, DECastro Jones R, Stewart A, Ubel, PA. (2017) Factors associated with success of clinician-researchers receiving career development awards form the National Institutes of Health: A longitudinal cohort study. Academic Medicine 92:(10): 1429-1439.

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Kinser, P.A., Loerzel, V., Matthews, E.E., & Rice, M. (2019). Call to action to support the success of midcareer nurse scientists. Nursing Outlook, 67(3), 252-258. doi: 10.1016/j.outlook.2018.12.013

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Krag, A. & Thiele, M. (2016). How to achieve a smooth transition from fellowship to faculty. United European Gastroenterology Journal. 45(5)717-718.

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LaCasce A, Graff S, Gao J, Close J & Boulmay B. (2019). Preparing fellows for graduation: Perspectives on Career Guidance. Am Sco Clin Oncol Educ Book, 39, 609-614. doi: 10.1200/EDBK_242603

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Mason, JL, Lei, M, Faupel-Badger, JM, Ginsburg, EP, Seger, YR, DiJoseph, L, Schnell, JD, Wiest, JS. (2013) Outcome Evluation of the National Cancer Institute Career Development Awards Program. Journal of Cancer Education 28:9-17. doi: 10.1007/s13187-012-0444-y

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McBride AB, Campbell J, Deming K. (2019). Does having been mentored affect subsequent mentoring? Journal of Professional Nursing, 35, 156-161. doi.org/10.1016/j.profnurs.2018.11.003.

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McBride, A.B., Campbell, J., Barr, T., Duffy, J., Haozous, E., Mallow, J., Narsavage, G., Ridenour, N., & Theeke, L. (2017). The impact of the nurse faculty scholars program on schools of nursing. Nursing Outlook, 65(3), 327-335. doi:10.1016/j.outlook.2017.01.013. McBride AB, Campbell J, Woods NF & Manson SM. (2017). Building a mentoring network. Nursing Outlook, 65(3), 305-314. doi:10.1016/j.outlook.2016.12.001. Meleis, AI, Editor (2010) Transitions Theory: Middle-range and Situation-specific Theories in Nursing Research and Practice. New York, Springer Publishing Company. Mehta, SJ and Forde, KA. (2013). How to make a successful transition from fellowship to faculty in an academic medical center. Gastroenterology, 145:703 -707. Nikaj S & Lund PK. (2019). The impact of individual mentored career development (K) awards on the research trajectories of early-career scientists. Academic Medicine, 94(5), 708-714

Journal Pre-proof National Institute of Nursing Research (2016). The NINR strategic plan: Advancing sci-ence, improving lives.NIH publication #16-NR-7783Bethesda, MD: National Institute of Nursing Research. Retrieved from https://www.ninr.nih.gov/sites/www.ninr.nih.gov/files/NINR_StratPlan2016_reduced.pdf Perumalswami, C.R., Griffith, K.A., Jones, R.D., Stewart, A., Ubel, P.A., & Jagsi, R. (2019). Patterns of work-related burnout in physician-scientists receiving career development awards from the National Institutes of Health. JAMA Internal Medicine. doi: 10.1001/jamainternmed.2019.4317. [Epub ahead of print]

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Physician scientist workforce report. (2014). Retrieved from https://report.nih.gov/Workforce/PSW/ps_workforce.aspx

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Porter-O’Grady, T and Malloch, K. (2017). Transitional Moments; reflections on fulfilling the professional role across a lifetime. Nurs Admin Q, 41(5)237-242.

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Saha, S, Saint, S, Christakis, DA, Simon SR, Fihn, SD. (1999). A survival guide for generalist physicians in academic fellowships. J Gen Intern Med, 14:750-755.

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Shea, J.A., Stern, D.T., Klotman, P.E., Clayton, C.P., O’Hara, J.L., Feldman, M.D., Griendling, K.K., Moss, M., Strauss, S.E., & Jagsi, R. (2011). Career development of physician scientists: a survey of leaders in academic medicine. American Journal of Medicine, 124(8), 779-787. doi: 10.1016/j.amjmed.2011.04.004

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Taylor DA, Broyhill BS, Burris AM, Wilcox MA. (2017). A Strategic Approach for Developing an Advanced Practice Workforce: From Postgraduate Transition-to-Practice Fellowship Programs and Beyond. Nurs Adm Q.41(1):11-19. DOI: 10.1097/NAQ.0000000000000198.

Journal Pre-proof Appendix 1. Interview Questions

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1. Thinking back to the first year (or 2-3) following your RWJ NFS or K award experience, what were the greatest challenges and opportunities you faced as you made the transition to your faculty roles? Please describe. 2. On a scale of 1 – 10 where 1 is the most difficult transition and 10 is the easiest possible transition, how easy was your transition? 3. What supports were most important to you during this time? Please describe these. 4. Which individuals within/outside your organization helped you with this transition? What did they do that you found helpful? 5. What factors made this transition difficult for you? Please describe them. 6. Which individuals within/outside your organization made this transition difficult for you? What did they do that you found unhelpful? 7. What recommendations do you have for supporting faculty colleagues as they complete a career development award such as the NFS and transition to a faculty role? For institutional support? For support from individuals? 8. Looking back on your experience, what would have been helpful for you to be doing ahead of the transition that might have made the transition easier? 9. What advice would you give someone who will be completing a career development award such as the RWJ NFS within the next year? How could they prepare for the transition?

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Figure 1. Box 1. Recommendations for Scholars during the Year Prior to the Transition (if not earlier)

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Communicate with deans and associate deans about your transition in advance, working with them to identify the next steps for you and your institution. o Focus on scholarship activities, e.g. need for multiple applications to obtain funding, need to plan for next grant before current funding is over. o Communicate about plans for the transition; plan actively. o Explore opportunities in the school before your return and how to give back to your institution. Understand redistribution of effort after the career development award ends including how to manage the work you have been doing coupled with additional teaching responsibilities and managing the service component such as leading governance and professional opportunities while advancing in rank. Learn how to consider and manage being recruited for new opportunities, e.g. to administrative or leadership positions. Anticipate difficulty when one stays in the same institution where one was a student: one is often viewed as the student rather than faculty colleague. Be strategic and goal-focused about your transition. Are you heading for an environment where you can thrive? One that will provide additional mentorship and optimal culture?  Prepare a plan for the transition, starting at least a year before the end of the award. o Keep options open, consider emerging roles, how to make an impact. If you are transitioning out of the institution, consider opportunities and increasing skills/roles needed. o Continue the discipline of developing and using the IDP for programmatic structure and goals, re-evaluation of goals and performance, and benchmarks for progress; create a 2-3 year plan for your transition period. Talk with mentors about what to anticipate after the program is completed, how to pursue your personal career development along with the home institutions’ activities. Consider the need to change institutions in order to experience a supportive environment in which there is a match between your expectations and that of the institution. Try to be flexible!!

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Box 2. Recommendations for Scholars during the First Years following the Transition to Faculty Roles  Start early in the career development program. o Start young, knowing there is not a balance between family and work and you will have to make some tough decisions. o Find time for research and publishing papers.  Know that the career development award is usually too short (only 3 years) to be ready to apply for R01 and you will most likely need a longer period to prepare for that. o Try to develop research teams and multiple collaborations so research does not hinge on getting a grant as a PI; Co-I support has helped with transition to getting funded. o Diversify research portfolio by going to institutes other than NINR.  Learn to manage grant funded projects. Scholars emphasized the need for continued skill building to manage research activities resulting from the challenges they experienced in the process. o Serve as a co-investigator on large grant funded projects with others to get experience with grant management. It can be overwhelming to receive R01 funding and learn how to manage a large grant at the same time! o Hire a professional coach (scientist). o Find someone to trust and work alongside to get research started and provide advice in times of need.  Arrange for mentorship. Mentorship needs spanned a wide range of capabilities, including: managing projects (akin to running a small business), learning how to set up a lab; garnering various levels of support through the university, deciding to delegate some aspects of one’s research/other work and best practices; serving as a coinvestigator on large projects. o Have an outside objective view even if there is an internal mentoring plan. o Find mentors within and outside of the organization. Honor your mentors to pay it forward, out of honor and respect for what you have received. o Help mentor early career faculty as a responsibility. o Discuss ways to engage others, e.g. new faculty and students who aspire to be part of the organization. o Engage with mentors inside and outside the school or organization to support engagement both within and beyond formal mentorship arrangements.  Be realistic about what it takes to succeed. Work closely with those who are willing to work with you and are respected inside and outside of the community. o Consider time protection to advance your career, e.g. finding people who can help develop career and ability to say no. o Work closely with faculty who are willing and bold enough to advocate for you.

Journal Pre-proof Table 1. Characteristics of Participants (N=10) Characteristic Cohort 2008 2009 2010 2011 2012

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Gender Female 7 Male 3 Race/Ethnicity White 4 Hispanic 2 African American 4 Geographic Area Midwest 4 Southeast 4 Pacific Northwest 1 Northeast 1 University – Research 7 Intensive Legend: Research intensive based on R1 Carnegie classification for doctoral universities.

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Highlights

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Fellowship transition to the full complement of faculty roles requires a balance of responsibilities to support career development, tenure and promotion Effective transition to the full complement of faculty roles includes intentional planning

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Investment in the successful transition of fellows to the full complement of faculty roles

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reaps benefits over the long term for the home institution and the individual.

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in anticipation of and after transition

Figure 1