Bridging the gap: Answering the need for nursing faculty

Teaching and Learning in Nursing (2009) 4, 109 114 www.jtln.org Bridging the gap: Answering the need for nursing faculty Diane L. Toto MSN, RN, Anya Bostian Peters MSN, RN, Bonita J. Blackman MSN, RN, Christine R. Hoch MSN, RN Department of Nursing, Delaware Technical and Community College-Stanton Campus, Newark, DE 19713, USA KEYWORDS: Nursing faculty shortage; Betty Neuman's systems theory; Bridge faculty; Associate Degree Nursing Program Abstract Delaware Technical & Community College's Associate Degree Nursing Program has made strides to combat the nursing shortage by increasing their admission rates by 40%. This expansion called for additional full-time nursing instructors; however, resources were limited. This inspired the Department Chair of Nursing to conceptualize a bridge faculty position. Using Betty Neuman's systems theory as a conceptual framework, bridge faculty were successfully integrated into an existing faculty structure. 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. New challenges have emerged as nursing school administrators work toward bridging the gap between an increasing student enrollment, lengthy admission waiting lists, and a decreasing pool of qualified nursing faculty. Faculty shortages in schools of nursing are limiting the ability of schools nationwide to accept qualified students. The American Association of Colleges of Nursing (2009) reported that 71.5% of the nursing schools responding to a 2008 survey pointed to faculty shortages as a reason for not accepting qualified applicants into nursing programs. This current nursing faculty shortage is placing considerable strain on nurse educators to meet the demands of future health care. To address this nursing shortage, Delaware Technical & Community College's (DTCC) Stanton Campus was asked by the state legislature to increase their Associate Degree Nursing Program enrollment. To support the increase in student enrollment, additional faculty positions were funded. The Department Chair of the Associate Degree Nursing Program developed a creative solution to assure the full-time Corresponding author. Tel.: +1 302 292 3884; fax: +1 302 292 3893. E-mail address: dtoto@dtcc.edu positions granted would support the increased student enrollment. This solution involved having one new fulltime faculty member function in two courses offered concurrently in each of the four semesters. This newly created bridge faculty position has helped to support current faculty as student enrollment increased by 40%. This article discusses the integration of bridge faculty into the Associate Degree Nursing Program at DTCC using Betty Neuman's systems theory (BNST) as a conceptual framework. Through the use of primary, secondary, and tertiary prevention/intervention strategies, bridge faculty were able to successfully integrate into an existing faculty structure and corporate culture. The personal experiences of the four bridge faculty members will also be discussed as they address the issues and challenges associated with a changing environment. 1. Overview of the associate degree nursing program DTCC is a state-supported community college with three campuses that is committed to providing open admission, post-secondary education at the associate degree 1557-3087/$ see front matter 2009 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.teln.2009.02.006

110 D.L. Toto et al. level. The Associate Degree Nursing Program at DTCC Stanton campus was established in 1973 and has graduated more than 2,500 nursing students. In 2002, the state of Delaware reported 500 vacancies for RNs in private hospitals and long-term care facilities (Delaware Health Care Commission, 2002). Following this report, a request came from the state's General Assembly to DTCC Stanton campus to increase nursing student enrollment. From 2002 until 2006, DTCC Stanton campus increased their student enrollment from 96 students per year to 160 students per year. The nursing program at DTCC Stanton campus is separated into four semesters consisting of eight nursing courses and supervised clinical practice. Each semester offers two concurrent courses (A and B). The first semester offers students two fundamental nursing courses. If successful, the students progress to the second semester where they complete courses in medical surgical nursing and maternal child health. The third semester consists of courses in medical surgical nursing and mental health. The fourth semester culminates with medical surgical nursing and community health/gerontology. Each of the eight nursing courses is team taught. Each team has three full-time faculty members who share the responsibilities of the course. Adjuncts, along with full-time faculty, are used in the clinical settings. Anticipating that the expansion would increase student enrollment by 40%, the Nursing Department Chair solicited eight additional faculty positions. However, resources were limited. This inspired the Nursing Department Chair to conceptualize a bridge position for the program. Faculty would bridge between the A and B courses at each of the four semesters (Fig. 1). Throughout the next 2 years, four fulltime bridge faculty members were hired and integrated into the current faculty structure. Following the integration process, the DTCC Stanton campus Associate Degree Nursing Program was successful in accommodating increased student enrollment, providing qualified faculty, and maintaining the high standards of the nursing program. 2. Betty Neuman's systems theory The premise of BNST involves two primary components: the client or client system (individual, group, or community) and their reaction to stress in the environment (Fawcett, 2005). For the purposes of this article, the client system is identified as bridge faculty, and the environment is identified as the current faculty structure of the Associate Degree Nursing Program at DTCC. As the client system interfaces with their environment, stress is produced. This stress can be either positive or negative. Positive stressors have a positive effect on the client system and usually produced a state of wholeness and wellness. Positive stressors can be both motivating and strengthening and typically result in a beneficial outcome (Walker, 2005). Negative stressors have the opposite effect and usually produce a state of instability. They are perceived by the client system as harmful and disruptive and usually have a negative outcome (Walker, 2005). How beneficial or disruptive a stressor is to the client system depends on several factors. Stressors can occur within Fig. 1 Model depicts the integration of bridge faculty into two concurrent nursing courses. Adapted from T. Porter-O Grady (1987) by permission of Jannetti Publications. Copyright 1987 Jannetti Publications.

Answering the need for nursing faculty the internal environment of the client system or the external environment of the client system. According to the Neuman theory, there are three types of internal and external environmental stressors that have the force to affect the stability of the client system: (a) intrapersonal stressor, which occurs within the client; (b) interpersonal stressor, which occurs between clients; and (c) extrapersonal stressor, which exists outside the client (Fawcett, 2005). The force an environmental stressor has on the client system depends on the strength of their lines of resistance and defense (Fig. 2). To strengthen the lines of resistance and defense in the client system, Neuman suggests the use of primary, secondary, and tertiary interventions and strategies (Fawcett, 2005). These interventions are designed to lessen or mitigate the impact of a negative stressor on the client system. The desired outcome of a primary, secondary, and tertiary intervention is to retain, attain, and maintain balance and stability in the client system (Fawcett, 2005). By using these three interventions, the bridge faculty members were able to achieve the desired outcome. Neuman's system theory provided a comprehensive, logical, and easily incorporated blueprint for integrating the bridge faculty position. 3. Integration process 111 As bridge faculty (client system) began the integration process and started interfacing with their environment (current faculty), several challenges arose. Two key components to a successful integration process were missing. First, a well-defined role was not mutually agreed upon between current faculty and bridge faculty, and second, a consensus did not exist related to course responsibilities and workload (Skalla & Hamric, 2000). These missing components led to interpersonal and intrapersonal stressors. Intrapersonal stressors encountered by the client system included feelings of confusion, frustration, exclusion, and apprehension. Perceived interpersonal stressors between the client system and the environment included unknown role expectations, ill-defined job description, differing faculty opinions, and confusion related to integration of bridge faculty. These stressors were forceful enough to penetrate lines of resistance and defense in the client system resulting in disharmony and imbalance. To correct this imbalance, bridge faculty instituted primary, secondary, and tertiary interventions. Fig. 2 Bridge faculty as client system using Betty Neuman s systems model. Adapted from B. Neuman and J. Fawcett (2002). Original Copyright 1970 by Betty Neuman. Adapted and reprinted with permission from Dr. Betty Neuman.

112 D.L. Toto et al. Defining a clear role description, mutually agreed upon by all parties, is paramount to any successful integration process (Skalla & Hamric, 2000). Because this crucial component was missing, bridge faculty had to begin with a secondary intervention to decrease intrapersonal and interpersonal stressors between the client system and the environment. This secondary intervention started with bridge faculty self-reflection, that is, asking themselves two questions: What is unique about this position and how does this uniqueness influence the support offered to each course? Bridge faculty decided that the uniqueness of the position comes in the form of role duality. Bridge faculty members straddle two concurrent courses, allowing them the distinct opportunity of having full insight into the intricacies of each course. This unique feature is unlike any other faculty position in the Associate Degree Nursing program. Expounding further, bridge faculty examined the core values inherent to the role. It was decided that four core values define this position: educator, collaborator, facilitator, and mentor. By identifying these core values and using the concept of role duality, a role description emerged. For example, using the core value of educator in a dual role enables bridge faculty to teach in both courses. They are prepared to teach clinically in both courses. They can be actively involved in developing test questions, evaluating course materials, planning and implementing teaching strategies, developing laboratory experiences, and arranging seminars for students in both courses. As a collaborator in a dual role, bridge faculty can attend and contribute to both course planning meetings, represent both courses on nursing department committees, and strive to enhance consistency between concurrent courses. As a facilitator in a dual role, bridge faculty can ensure multidirectional communication between courses, faculty, and students; collect data and statistics pertinent to both courses; evaluate student progress in both courses; and streamline paperwork. As a mentor in a dual role, bridge faculty can assist students simultaneously in both courses with issues such as course content, organization, questions about assignments, clinical issues, projects, due dates, resources, stress reduction, and time management. Now that a role description was taking shape, the next step was for current faculty and bridge faculty to reach a consensus on how course responsibilities and workload would be divided. Immediately, opinions differed. For example, one course would assign bridge faculty a seminar or laboratory but not include them in course meetings and test analysis. Other courses would share information in course meetings and test analysis but assign no lecture content or laboratory time. Because the delegation of course responsibilities was somewhat lopsided, bridge faculty felt they were being underutilized and not contributing to their full potential. One bridge faculty member commented, I feel like an adjunct with an office. Another commented I thought this was supposed to be a 50/50 sort of thing. One course is giving me a lot of work and the other hardly anything. I feel like an outsider looking in. Incongruencies between bridge faculty's concept of their role and current faculty's perceptions of the role led to tension. Interpersonal stressors between current faculty and bridge faculty included confusion over redistribution of course work, anxiety over change, and insufficient direction. To mitigate these stressors, bridge faculty instituted another secondary intervention with the purpose of attaining system stability. These interventions involved diplomacy, leadership, and advocacy. Bridge faculty worked diligently to advocate for their position. They gradually and diplomatically negotiated for more course responsibilities. Bridge faculty asserted that to fully integrate into the Associate Degree Nursing program and to function efficiently among faculty and an increasing student population, certain ideal conditions should be in place. These ideal conditions, based on the theory of shared governance, included an equal distribution (50/50) of course responsibilities and workload between concurrent courses, multidirectional communication between concurrent courses and bridge faculty, informed and inclusive decision making, transparency of operations, autonomy, and trust (Porter-O'Grady, 2000). Bridge faculty continually advocated for these ideal conditions when interacting with each of their faculty teaching teams. Through advocacy, leadership, and at times diplomacy, these ideal conditions gradually fell into place. As they did, the concurrent courses became more synchronized in how they delegated course responsibilities and workload. Bridge faculty began teaching content in both courses, conducting seminars, developing laboratory experiences, and spearheading community projects. They were included in all course planning meetings, test construction and analysis, and decisions impacting their courses. As a result, they were able to immerse themselves fully into the student population, which allowed for deeper insight into such issues as student progress, student concerns, and inconsistencies between concurrent courses. Striking this balance led to a more productive and efficient use of bridge faculty. In turn, interpersonal and intrapersonal stressors between the client system and the environment decreased. Flexible lines of defense and resistance were strengthened. One particular area of interest to bridge faculty was promoting consistency between concurrent courses. Consistency between nursing courses is extremely beneficial for both faculty and students. In contrast, developing inconsistent procedures and processes can and will increase the risk for errors and problems (Keerfoot, 2006). One suggestion for improving consistency between concurrent courses involved streamlining certain tasks through the bridge faculty member. For example, students are required to complete independent laboratory hours, attend math workshops if they are struggling with math

Answering the need for nursing faculty test questions, and complete end-of-semester faculty and course evaluations for each of their concurrent courses. Bridge faculty is now in charge of these course responsibilities in each of the concurrent courses. In another example, bridge faculty noticed that students in the concurrent courses were using different databases and care plans in the clinical settings. It was suggested that the databases and care plans become similar in format and use. Working with each concurrent course, the forms were customized and then formatted to resemble each other. Promoting consistency between these two forms allowed students a greater opportunity to master their use, with less time required by faculty for direction and input. If students did have questions, they only had to meet with the bridge instead of making two separate appointments with two separate faculty members. As one bridge described it, It's like one stop shopping for the students. Another example of promoting consistency between concurrent courses occurred when a bridge faculty member reviewed the nursing skills being taught in each of the first-level fundamental courses. Bridge faculty facilitated a collaborative partnership with both teaching teams, so a better understanding of how the two courses support and enhance each other could be investigated. The two teaching teams met and discussed how certain theory and skills could be divided to provide content consistency. Ultimately, this consistency would provide the student a better chance to master the theory and skills taught in each course. Bridge faculty, because of their unique position, can support students in a variety of ways. Employing instructors who are knowledgeable about both courses eliminates many student barriers. Bridge faculty's cognizance of at-risk students in both courses allows for opportunities to mentor students about study habits, stress and anxiety management, and available resources. The individual contact and support that bridge faculty can offer to at-risk students often provides the extra motivation and perseverance for some students to succeed (Higgins, 2005). For example, the bridge faculty member at the third level of the curriculum, which bridges medical surgical nursing and mental health, stated the following: If a student is failing mental health, but is currently in their medical surgical clinical rotation, they may not have the opportunity to speak to their mental health instructor about their concerns. Having the ability to provide students with support for both courses benefits the students. It allows the bridge to view the student as a whole and not just as a medical surgical student or a mental health student. It fosters support, by showing the student that someone is concerned about how they are doing as a whole. This added support system fosters the student faculty relationship in a positive way. According to Johnson and Halstead (2005), The student faculty relationship that is developed during the teaching and learning process is a very important one. Students have identified student faculty relationships as the relationships that most often affect learning (p. 64). Throughout the semesters, interpersonal and intrapersonal stressors continually decreased between the client system and the environment. Flexible lines of defense and resistance strengthened. This strength brought stability and harmony to the integration process, allowing it to move in a positive direction. Secondary interventions were no longer needed. Bridge faculty members used primary intervention strategies to retain stability. Primary intervention strategies promote a state of wellness by continuing to strengthen and expand flexible lines of defense through stress reduction and reduction of risk factors (Ume-Nwagbo, DeWan, & Lowry, 2006). For bridge faculty, these primary interventions included staying visible, present, and included. As one bridge stated, I need to stay in the loop, otherwise it will be detrimental to my ability to assist students and faculty equally with both courses. A good example of an application of a primary intervention strategy occurred when some bridge faculty members were not scheduled to attend orientation classes that students were required to attend at the start of the semester. On many occasions, bridge faculty would be scheduled to attend one course orientation but not the other concurrent course's orientation. Bridge faculty advocated that students should be introduced to the role of bridge faculty at the beginning of the semester because they need to understand the role if they intend to utilize the bridge faculty member to their advantage. Now, it is customary that bridge faculty members attend both course orientations. This small but important strategy in role promotion successfully mitigated a potentially negative stressor between the client system and their environment. Bridge faculty members continue to support faculty and students through tertiary interventions. Tertiary interventions are designed to add energy and support to the client system and are rehabilitative in nature. According to Stephans and Knight (2002), Tertiary interventions are designed toward wellness maintenance, serving to protect the client system's reconstitution or return to wellness following treatment (p. 332). Tertiary strategies used by bridge faculty members included the following: improving the knowledge base related to both courses by attending outside seminars and workshops, establishing an ongoing mentoring system among bridge faculty members, staying actively involved in professional organizations geared toward each of the concurrent courses, developing a job description for bridge faculty members, mentoring new bridge members, and seeking certification in specialty courses. 4. Conclusion 113 According to Boland and Finke (2005), New educational models are being designed based on the premise

114 D.L. Toto et al. that nurse educators must seek new ways of preparing the next generation of nurses. Nurse educators cannot hold on to the traditional models given the rapidly changing nature of health care and education (p. 161). Integrating bridge faculty into a well-established, traditional, and highly respected faculty structure has been both exciting and challenging. Nursing faculty has embraced this opportunity to further advance the exceptional qualities embedded within the Associate Degree Nursing Program at DTCC. Leadership, diplomacy, collaboration, and camaraderie have all been instrumental in creating the path for bridge faculty. BNST was key in addressing many of the issues involved when traditional, organizational models in nursing education are no longer able to sustain the pressures of a changing environment (Huber, 2000). After several semesters of assimilating bridge faculty into the current faculty structure, the synergistic benefits are apparent. Bridge faculty members are continually working to their full potential to support faculty and students. 5. Recommendations Additional qualitative investigation would be beneficial to determine how the students perceive the role of bridge faculty. Development of a surveying tool to assess students' perceptions is a future endeavor of bridge faculty members. Investigation of end-of-year statistics related to student progress throughout the curriculum would be a potential area of research to examine the effects of the bridge position on student success. Acknowledgments We thank Dr. Kathy Janvier, RN, PhD, for her vision with this project; Kristin Yonko for her guidance in writing the manuscript; and Elizabeth Stamper for preparing the artwork. References American Association of Colleges of Nursing. (2009). Nursing faculty shortage. Retrieved August 19, 2009, from http://www.aacn.nche.edu/ media/factsheets/facultyshortage.htm. Boland, D. L., & Finke, L. M. (2005). Curriculum designs. In D. M. Billings, & J. A. Halstead (Eds.), Teaching in nursing a guide for faculty (pp. 161). 2nd ed. St Louis, MO: Elsevier Saunders. Delaware Health Care Commission Committee On Nursing Workforce Supply. (2002). Solving the nursing shortage in Delaware: Key findings and recommendations. Dover, DE. Retrieved August 10, 2009, from http://www.dhss.delaware.gov/dph/hsm/files/nurshortinde.pdf. Fawcett, J. (2005). Neuman's systems model. In J. Fawcett (Ed.), Contemporary nursing knowledge: Analysis and evaluations of nursing models and theories (pp. 166 222). 2nd. ed. Philadelphia: F.A. Davis. Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates. The Journal of Nursing Education, 44(12), 541 542. Huber, D. (2000). Decentralization and shared governance. In D. Huber (Ed.), Leadership and nursing care management (pp. 497 514). 2nd ed. Philadelphia: W. B. Saunders. Johnson, E. G., & Halstead, J. A. (2005). The academic performance of students: Legal and ethical issues. In D. M. Billings, & J. A. Halstead (Eds.), Teaching in nursing: A guide for faculty (pp. 41 66). 2nd ed. St. Louis, MO: Elsevier Saunders. Keerfoot, K. (2006). Reliability between nurse managers: The key to the high-reliability organization. Nursing Economics, 24(5), 274 275. Neuman, B., & Fawcett, J. (2002). The Neuman systems model (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Porter-O'Grady, T. (2000). Tim Porter-O'Grady envisions shared governance. In D. Huber (Ed.), Leadership and nursing care management (pp. 508)., 2nd ed. Philadelphia: W.B. Saunders. Porter-O'Grady, T. (1987). Shared governance and new organizational models. Nursing Econimic$, 5(6), 281 286. Skalla, K., & Hamric, A. B. (2000). The blended role of the clinical nurse specialist and the nurse practitioner. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Eds.), Advanced nursing practice: An integrative approach (pp. 459 490). 2nd ed. Philadelphia: W. B. Saunders. Stephans, M. B. F., & Knight, J. R. (2002). Application of Neuman's framework: Infant exposure to environmental tobacco smoke. Nursing Science Quarterly, 15(4), 327 334. Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, L. W. (2006). Using the Neuman systems model for best practices. Nursing Science Quarterly, 19(1), 31 35. Walker, P. H. (2005). Neuman's systems model. In J. J. Fitzpatrick, & A. L. Whall (Eds.), Conceptual models of nursing: Analysis and application (pp. 194 224). 4th ed. Upper Saddle River, NJ: Pearson Prentice Hall.