Nurse Educator Shortage: Philosophy and Meta-Paradigms

Introduction

Quality initiatives, magnet status, and patient safety require that nurses practice on the basis of professionalism at all times. Owing to the rapid changes in practice and knowledge facing the profession, the specialty of school nursing has embarked on efforts to articulate its value in the educational arena. The specialty and the profession are maturing, and nurses are beginning to make their scopes of practice and roles more clear. Changes in demand and expectations have, however, spurred a shortage of qualified nurse educators, which is threatening to destabilize the quality of care.

The nurse educator role requires that an individual undergo specialized preparation and be actively involved in the implementation of strategies "that will serve to retain a qualified nurse educator workforce" (NLN, 2002). However, the looming crisis is impacting this course of action; the gap between work hours and resources is widening, negatively affecting job satisfaction, and pushing nurse educators to reexamine their values in search of meaning and balance in the work setting. The only sure way to maintain professionalism and ensure that one's practice remains in harmony with their value system is to have a personal philosophy.

The nurse educator role mandates the integration of professional education and the liberal arts in the advancement of nursing education as well as in the conduct of pedagogical research (McAllister, 2012). The National League for Nursing (NLN) asserts that "nurse educators are the key resource in preparing a nursing workforce that will provide quality care to meet" the population's healthcare needs (n.p.). Nurse educators practice in both clinical and academic settings, and ought to display competence and professionalism in their core areas of responsibility: (i) the professional development of nurses; (ii) the graduate preparation of nurses for the roles of scholar, leader, advanced generalist, and advanced practitioner; and (iii) the preparation of baccalaureate generalists for the provision and coordination of direct and indirect care (Robinson, Jagim & Ray, 2004).

Background and Significance of Nursing Education

Every discipline has meta-paradigm concepts that represent its global perspective and act as "an encapsulating unit, or framework, within which the more restricted structures develop" (Masters, 2014, p. 48). The nursing profession is governed by four central concepts: nursing, health, environment, and person.

Nursing can be defined as an intellectual discipline, a humanistic science, and an art of informed caring (Masters, 2014). Informed caring forms the basis of nursing and is represented as a nurturing way of interacting with people toward whom one is professionally committed. In this context, nursing exists as a discipline that assists persons in achieving quality of life, well-being, and health by directing its integrated and diverse elements in a person-centered way (Masters, 2014; Robinson, Jagim & Ray, 2004).

Nursing Education and the Meta-Paradigms of the Profession

McAllister (2012) points out that the term health derives its basis from the word whole, and that it represents a person's multidimensional nature. The different dimensions of a person interconnect harmoniously to give rise to well-being and health (McAllister, 2012). These dimensions are further influenced by the culture and society within which an individual lives, which implies that an individual's health is dependent upon a number of internal as well as external factors. Persons influence their well-being and health through their life choices. However, everyone has a right to take part in decisions that affect their health, well-being, and quality of life — including decisions related to prevention and the promotion of healthy living.

Environment collectively covers all local and global features that influence health-related behaviors and overall well-being (Masters, 2014). This concept provides nurses with a framework for understanding the effect of external components on the well-being of persons. The nurse's role is to facilitate the creation of a health-friendly environment. To do this, nurses must first understand how features such as resources, beliefs and values, and individual and family relationships influence a person's physical living space. This calls for the development of inter-professional collaboration, with the aim of optimizing the management of each individual's needs in a cost-effective manner.

Person refers to the client, who could be an individual, a family, a community, a population, or a system. The concept of person covers the bio-physical, psychological, social, cultural, and spiritual dimensions brought into an interaction. To this end, the person is at the center of care and is the nurse's key to understanding the effects of the various health-influencing factors — and, subsequently, to providing coordinated and compassionate care (Masters, 2014).

At the baccalaureate level, the health interaction — nested in the concept of informed caring and ethical practice — is the professional relationship between the nurse and the person (Redman, Lenburg & Walker, 1999). Its goal is to support the person's movement toward optimum well-being. The nurse therefore interacts with the person as a collaborative leader in four roles: the professional role, the inter-professional collaborator role, the provider of direct and indirect care, and the care coordinator role (Redman et al., 1999).

The health interaction is defined by an ethical framework that appreciates diversity and incorporates the law, professional ethics, advocacy, and moral concepts. The nurse implements a facilitative process of leadership to assist the person in disease management and prevention, health restoration, and the promotion of healthy living behaviors (Redman, Lenburg & Walker, 1999; McAllister, 2012). This leadership is demonstrated by a willingness to identify and address complex problems in a person-centered and ethical manner (Masters, 2014). The nurse's knowledge is derived from aesthetic, personal, and empirical ways of knowing, and is built on a strong foundation of professional service, clinical competency, and the liberal arts (Redman et al., 1999).

The Nurse Educator's Conceptual Framework

At the graduate level, the nurse uses the baccalaureate foundation to instill conceptualization skills and higher-level thinking, with the aim of enabling the person to implement systems change (Redman, Lenburg & Walker, 1999). Nurses at the master's level are prepared to design person-centered care approaches and implement change through inter-professional collaboration and research evidence (Redman et al., 1999). They use scientific knowledge to optimize health while taking into account the complex dimensions of information management, organizational structure, finance, and policy (Redman et al., 1999).

Transformational leadership is the professional relationship between the nurse and the person as the two interact in four advanced professional roles: contributor to the profession, inter-professional collaborator, coordinator and manager and designer of systems, and provider of direct and indirect complex care (Redman, Lenburg & Walker, 1999). In this transformational leadership role, the nurse advocates for, implements, and evaluates change toward promoting an environment that both challenges and supports the person in transforming their vision into reality (Redman, 1999). To this end, the nurse values each person's contribution to the delivery of care and exemplifies behaviors that lead to quality improvement while establishing a climate of open communication to facilitate advocacy (Redman, 1999).

Concern has been raised "about the number of faculty available to teach in our nursing programs, and the extent to which those individuals have been adequately prepared for the role" (NLN, 2002). Currently, the number of nursing programs is approximately 3,500, with around 2,500 nursing schools and a student population of approximately 500,000 (Resop Reilly, Fargen & Walker-Daniels, 2011). With the projected nurses' shortfall and the increasing healthcare needs of the diverse, aging Baby Boomer generation, schools will be forced to increase their enrollment by up to one-third of the current student population (Resop Reilly, Fargen & Walker-Daniels, 2011). This could see the student population in nursing courses reach 700,000 over the next half-decade.

Using a 10:1 student-to-faculty ratio, the number of fully engaged faculty members required would be 70,000. Empirical figures suggest that currently only about 70% of that number — roughly 48,670 nurse educators — are available (Siela, Twibell & Keller, 2009). The supply of qualified nurse educators is shrinking significantly for three major reasons: a significant number of retiring faculty members, most of whom were qualified educators; fewer graduate programs offering nursing education specialties; and declining graduate program enrollments (Siela, Twibell & Keller, 2009; Resop Reilly, Fargen & Walker-Daniels, 2011).

Conclusion

Nursing schools have been experiencing faculty shortages for a considerably long period of time. With nursing school enrollments increasing, the need for more nursing faculty is becoming more acute; yet there is a very small pool of qualified professionals available to meet the rising demand. Three phenomena have been identified as contributing to the looming crisis, which threatens to destabilize the quality of care: the retirement of many faculty members, a limited number of graduate programs offering nursing education specialties, and declining graduate program enrollments. The result is that the few available educators must serve larger student populations and work longer hours — circumstances that negatively affect job satisfaction and have led many nurse educators to reexamine their values in search of meaning and balance. What stands out, however, is that having a personal philosophy remains the surest way to maintain professionalism and ensure that one's practice stays in harmony with one's value system.