Fostering Sound Relationships in Nursing Education Through Faculty and Student Mentoring
Submitted by Nancy Bellucci, PhD, MSN-Ed, MS, RN, CNE, CNOR
The relationship between the student and the faculty member should find its foundation in open communication and mutual respect. The faculty member and academic administration are required to facilitate a learning environment that promotes a just culture, is conducive to learning, and aids students achieve desired didactic and clinical outcomes (National League for Nursing (NLN), 2005). Likewise, the nursing profession is required to abide by professional standards and a code of ethics. These standards and codes of ethics serve as a guiding force throughout the nursing career. In all of the interactions, nurses have while caring for patients and representing an institution. The NLN (2007) created an excellence model to identify eight core elements necessary to attain and maintain excellence in the nursing profession. Additionally, the NLN (2007) stressed that the nurses need to understand the principles that are fundamental to their profession, use technology to manage and find information, and be leaders and agents for change.
Likewise, students require strong mentoring to understand his or her potential role as a nurse. Further, faculty members require mentoring to be effective leaders in the classroom and clinical areas. Culleiton and Shellenbarger (2007) identified that providing active mentorship during the novice educator's transitioning phase is a helpful strategy that is useful for enhancing effective transitioning for the new educator. Therefore, effective mentoring programs provide a strategy for improving retention in nursing (Culleiton & Shellenbarger, 2007). Further, equal importance is placed upon the facilitation of positive faculty-to-student relationships while the faculty member transitions into the role.
The American Association for the Colleges of Nursing (2014) indicated that the United States faces a major nursing shortage and an increase in workforce opportunities in the next eight years. The Institute of Medicine (IOM) (2011) recommended that all nurses have a Bachelor's of Science in Nursing (BSN) by the year 2020. The IOM's recommendations create an emergent need to increase the nursing faculty workforce. Nursing is one of the many vocations in which a growing need for improvement of workforce retention exists.
In the wake of a nursing faculty shortage, there is a need to retain current faculty and recruit new faculty. Academic institutions and health care facilities are responsible for the retention of nursing faculty. An important component of maintaining work environments conducive to retention of the nursing faculty workforce is associated with the provision of adequate mentorship. Health Resources and Services Administration (HRSA) (2010) indicated that the primary problems facing healthcare are: financial constraints, healthcare workforce shortages, the changing needs of an aging population, which have prompted a national dialogue on the need for new healthcare models to meet the healthcare demands of the 21st century, facilitation of working nurses' abilities to participate in continuing education programs and increasing healthcare information technology demands. Medical schools, institutions, practitioners, and students will be required to create strategies for coping with the increased volume of new information and changing patient demographics (HRSA, 2010).
Improving the Student-Faculty Member Relationship through Mentoring
Faculty mentoring is a critical component to the success of a program. Kapustin and Murphy (2008) explained that mentoring is a relationship between a seasoned and novice professional that aids in developing the novice individual to be a productive component of the faculty team. The goals of faculty mentoring are to assist the novice faculty member in overcoming obstacles encountered in daily work, improving individual productivity, and increase employee satisfaction (Kapustin & Murphy, 2008). Jacobsen and Sharrod (2012) asserted that mentoring is effective for the faculty member and contributes to the increased awareness on the part of the student via interaction, sharing of enthusiasm, and formulation of new insights that contribute to the advancement of teaching styles.
There are many issues to consider when mentoring or receiving mentorship. Veltri and Warner (2012) indicated that the nursing profession has a responsibility to remain vigilant regarding influences that change the direction of not only the profession but in nursing education. Further, nursing educators must work to adapt the changes in a curriculum to model the changes that occur in society, political climate, demographics, economics, workforce trends, and any external or internal issues that may influence change in the way nurses deliver care (Veltri & Warner, 2012). For change to occur in a curriculum and to build meaningful learning experiences for students, nursing educators need to prepare the nursing student by continually analyzing those forces that impose change and encouraging interpersonal dialogue between students and in the student-faculty relationship (Veltri & Warner, 2012). Therefore, Veltri and Warner (2012) stressed the need for academic administration to construct methods for assessment and to provide the tools to monitor changes as they relate to curriculum design and redesign. Further, Veltri and Warner (2012) asserted that imposing change without assessment and communication will create an ineffective learning environment.
Types of Mentoring Programs
Wilson, Andrews, and Leners (2006) indicated that mentoring effectively enhances cultural diversity in the profession of nursing and academia. Further, Wilson et al. (2006) indicated four main mentoring strategies to be employed to encourage academic success. Those strategies encompass communication, professional leadership, confidence-building activities, and students (Wilson et al., 2006). In correlation, Valencia-Go (2005) indicated that a successful mentoring program is dependent upon a strong infrastructure.
Shadowing is another method of mentoring. Sternszus, Cruess, Cruess, Young, and Steinert (2012) indicated that shadowing is now a tool for medical residents. The assignment of medical residents to nursing staff, as each makes patient rounds, serves to educate the resident about the role of the nurse (Sternszus et al., 2012). Sternszus et al. 's (2012) study served to identify the importance of residents as role models, and the impact role modeling had on undergraduate medical students.
The Robert Wood Johnson Foundation (RWJF) has initiated several mentoring programs such as RWJF Nurse Faculty Scholars Program, RWJF New Careers in Nursing Program, RWJF Executive Nurse Fellows Program, and New Jersey Nursing Initiative Faculty Preparation Program. The American Association of the Colleges of Nursing and RWJF (2013) offered a mentoring tool kit that aids in defining mentoring, identifying effective mentor candidates, promoting mentor/mentee relationships, and effective closure of mentor/mentee relationships. RWJF (2013) identified mentoring as an ongoing and collaborative relationship whose purpose is to develop and build relationships between a novice and a seasoned professional. RWJF (2013) and the Institute of Medicine (IOM) (2010) indicated that mentoring benefits everyone involved in the business of healthcare.
Review and Recommendation of a Faculty Mentoring Program
The Sigma Theta Tau International (STTI) Honor Society of Nursing (2014) announced the formation of a nursing faculty leadership academy that is a nursing mentoring program that facilitates the transition of potential faculty candidates into faculty roles within colleges and universities. The program is 21-months in duration and pairs mentees (also known as scholars) with mentors in nursing academia to aid in fostering the successful transition from the novice-to-experienced faculty member, promotion of nurse faculty retention, development of leadership and interpersonal communication skills, and cultivation of higher-performing work environments (STTI, 2014). The STTI Nurse Faculty Leadership Academy (NFLA) also facilitates expanding the scope of influence that a junior faculty member has within the institution where they work and within the profession.
Review and Recommendation of a Student Mentoring Program
Valencia-Go (2005) identified a program called Growth and Access Increase for Nursing Students (GAINS) as one funded by the Department of Health and Human Services (DHHS) and proposed to increase the retention rate and success rate in Baccalaureate programs from 50% to 70%. Valencia-Go (2005) indicated that GAINS was the first initiative of its kind that was federally-funded. The purpose of GAINS is to provide support and resources for students to complete the Baccalaureate program (Valencia-Go, 2005) successfully. The components of the GAINS program encompass the importance that the roles advisement, peer-tutoring, pre-licensure experiences, mentoring, faculty development, project team consultation play in the success of the student.
Ethical Standards, Just Culture, and the Faculty-Student Relationship
According to Corless and Nicholas (2006), ethics and standards in nursing are principles associated with values, human conduct, and consideration for others. Nursing ethics, in particular, are ethical principles that guide practice (Corless & Nicholas, 2006). The principles related to nursing ethics and bioethics overall are beneficence, nonmaleficence, autonomy, justice, and fidelity. Each of these principles contributes to the foundation of nursing education and practice principles, and standards of practice devised by organizations, such as the American Nurses Association (ANA), the International Council of Nurses (ICN), and the American Association of University Professors (AAUP).
According to the American Nurses Association (ANA) Code of Ethics 6.3, the nurse has a responsibility to contribute to an environment that encourages transparency, support, effective interpersonal communication, and respect (ANA, 2001, p. 11). NLN (2012) indicates that another component of the guiding principles for nursing education is integrity. To exhibit integrity, it requires one to treat others respectfully while communicating courteously and positively (NLN, 2012). Additionally, the NLN identified diversity as an important guiding principle. The NLN (2012) position on diversity maintained that the faculty member supports open communication, fosters uniqueness, utilizes innovative teaching strategies regardless of race, gender, religion, age, financial status, physical abilities, or other belief systems (NLN, 2012). The NLN (2012) indicated that to create an environment that supports diversity. All persons should provide open and respectful exchanges (NLN, 2012). This is not limited to the faculty member.
Some of the ways that faculty can achieve creating a just culture is to encourage the students to engage in self-reflection, promote professional practice standards within the curriculum, and be effective role models for collegial behavior (NLN, 2005; ANA, 2010). The ANA (2010) identified that intimidation and disruptive behaviors foster medical error and create poor patient satisfaction, increase the cost of care, and cause knowledgeable clinicians to leave the workforce in search of new professions, thus increasing turnover and shortage rates. Therefore, the faculty can engage and empower the student by creating a culture that is free from intimidation and punitive sanctions ANA, 2010).
Ten best practices to be used to incorporate standards into nursing practice and nursing education, which are: 1) support the nursing code of ethics; 2) offer ongoing education; 3) create an environment where nurses can vocalize concerns; 4) employ interdisciplinary and interprofessional learning; 5) enlist nurse ethicists to speak to nurses; 6) provide unit-based ethics mentors (for practice); 7) hold a family conference (in the practice setting); 8) sponsor an ethics journal or club; 9) reach out to other professional associations for resources; and, 10) offer employee or student counseling services (Wood, 2014). The ANA Code of Ethics, for instance, is a framework for nursing practice. (ANA, n.d.). Therefore, nurses should be familiar with this code and utilize it as a personal framework for practice (Wood, 2014). The ICN standards can also be integrated as the cultural diversity component of ethical practice. Lastly, the AAUP (n.d.a.) standards, as they apply to the educator, can be provided by way of the institution where the educator is employed and also be a part of the mission statement for the school.
Academic Freedom and Ethical Decision Making for Faculty
Many ethical challenges face the faculty daily and have an impact on the academic freedom he or she is entitled to as an educator. Issues such as academic dishonesty, grade inflation, and inconsistency in competency assessment are just a few that plague the daily workflow. The lasting effects of these challenges can be daunting, and the educator's symptomology (i.e., moral distress) can go completely unrecognized until there is a problem. The AACN (n.d.) indicated that moral distress could present via personal issues, interpersonal relationships, or environmental issues.
Negative Role Models
Negative role-modeling, horizontal violence, and aggression on the part of faculty or nurses in the clinical setting each serve to promote barriers in learning for the nursing student. A study performed by Hawthorne, Machtmes, and Tillman (2009) identified that barriers related to negative role modeling, such as passive-aggressive and threatening behavior and negative faculty and clinical staff attitudes, impede learning and threaten student progression and retention in nursing programs. Low retention rates of nursing students directly impact the matriculation of more nurses into the nursing profession, where a shortage already exists (US Department of Health and Human Services (HHS), 2010). Hawthorne et al. (2009) asserted that students who cannot identify with the nursing profession or fail to become socialized within the profession would eventually leave. Further, Hawthorne et al. (2009) purported that for nursing students to become effectively socialized in the profession, positive role models must be present, and nurturing of the student must occur.
Negative role models infringe upon the students' ability to learn and contribute to a negative psychosocial learning environment (Hawthorne et al., 2009). As the need for new nurses grows concerning an encroaching nursing shortage, effective management of the clinical setting related to students' ability to think and effectively learn critically is vital. Two major themes emerged via a recent literature review. The first theme that emerged relates to the identification that horizontal violence is evident in the clinical rotation setting (Cooper, Walker, Askew, Robinson, & McNair, 2011). Horizontal violence correlates with a decrease in a nursing student's ability to learn or think critically (Pines, Rauschhuber, Norgan, Cook, Canchola, Richardson & Jones, 2011). The second theme that emerged from the literature review relates to the correlation between horizontal violence and a perceived decrease in the nursing students' ability to learn or think critically (Jackson, Hutchinson, Everett, Mannix, Peters, Weaver, & Salamonson, 2011).
Ethical Challenges and Moral Distress
Ethical issues such as academic dishonesty, grade inflation, and inconsistency in competency assessment are just a few that plague the daily workflow. The effects of such challenges can be daunting, and their symptomology can go completely unrecognized until there is a problem in the dynamic of the classroom. The American Association of Critical-Care Nurses (AACCN) (n.d.) indicated that sources of moral distress could present via personal issues, interpersonal relationships, or environmental issues. Likewise, the AACCN (n.d.) indicates that conflicts and disrespectful interactions can cause moral distress. Moral distress can cause exhaustion and consequential decision-making related to professional performance in a field.
The AACCN (n.d.) asserted that moral distress occurs in working groups and occurs in the form of increased turnover, defensiveness, lack of collaboration, and trust, coupled with a lack of effective communication. Other barriers that may contribute to moral distress are skill level, low self-esteem, fear, and lack of awareness of the offensive behavior (AACCN, n.d.). Time constraints and lack of administrative support or issues with institutional policy tend to confine a person, especially when met with situations that cause ethical conflict. (AACCN, n.d.). Ganske (2010) asserted that collegial incivility attributes to the moral distress of the faculty member. Collegial incivility is a group of behaviors that include but are not limited to the act of rudeness, bullying, psychological abuse, undermining of activities, disdain, passive-aggressiveness, and disruptive behavior (Ganske, 2010).
Meeting the Needs of a Changing Society
Leaders in the nursing profession and nursing education need to have a global perspective, working knowledge of technology, expert decision-making skills, the ability to create a culture that promotes quality healthcare and safety, team-building, and is forward thinking in a changing environment (Veltri & Warner, 2012). Likewise, leaders in the nursing profession and nursing education also need to employ strategies to affect change while encouraging the successful implementation of change as the issues emerge. Educators must take a proactive approach to change by consistently reviewing the curriculum, and the modes for delivery, along with the assessment of changes imposed by internal and external issues.
The emergence and growth of the online learning environment have increased the need for nurses and faculty (Holly, 2009). Further, Holly (2009) identified that distance education allows nursing educators to meet the recommendations of the National League for Nursing (NLN) for advancements in nursing informatics education. However, there is still a growing need for nursing educators that is imposing a gap toward the ability to matriculate nurses into the profession (Holly, 2009). Therefore, schools of nursing will need to create programs to onboard faculty and mentor new faculty to ensure retention.
There is a driving need to develop the knowledge and skills necessary to meet the demands and interpersonal issues evident in today's patient populations (Wilcock, Janes & Chambers, 2009). Today's faculty members will need to address the needs of a changing society, act as change agents for progress, and be skilled and knowledgeable of technological advances. Further, today's students need creative learning environments that encourage ethical standards, promote effective interpersonal behaviors, and educate students in rendering multidisciplinary care. The future of health care delivery systems will rely on a multidisciplinary approach to rendering safe and effective care. With the management of care serving to emerge as a critical component in health care delivery, nurses must exhibit leadership and skill in interdisciplinary and collaborative practice to improve health care delivery and quality.
Thus, the faculty member must incorporate methods to increase interdisciplinary collaboration, education, practice, and exchanges. Furthermore, the faculty member is charged with preparing current and future nurses for growth in their respective roles as members of the interdisciplinary health care team. Nurses are being called upon to fill expanding roles and to master technological tools, information management systems while collaborating and coordinating care across teams of health professionals. Therefore, the faculty member must prepare future nurses for the clinical environment that awaits them.
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