Leveraging a Successful Faculty Practice Model to Recruit and Retain Early-Career Nurse Faculty

Abstract

Background: 

The shortage of nursing faculty is well documented as are the challenges of attracting and retaining early-career faculty, in part, due to difficulties transitioning expert clinicians into faculty roles.

Problem: 

There is little guidance in the literature describing successful formal transition models.

Approach: 

An urban College of Nursing Faculty Practice (CON FP) underwent an operational redesign beginning in 2014, resulting in an intentional success: a pipeline for attracting and developing early-career faculty. This article describes how the CON FP leverages faculty practice to develop early-career faculty.

Outcomes: 

Across a 6-year time span, at least 20 early-career CON FP clinicians have transitioned to full-time faculty roles. In addition, CON FP clinicians provide more than 75 000 direct care nursing services and support more than 25 000 student clinical and project hours annually.

Conclusions: 

We offer this early-career faculty practice pipeline model as a solution for attracting and growing a contemporary nursing faculty workforce.

Recruitment and retention of expert nurse clinicians into faculty roles remain an underaddressed, multifaceted challenge¹ essential to addressing the national nursing shortage in the United States.^2–4 It is critical that schools of nursing develop an intentional model for attracting nurses into academia and ensuring those new academics are prepared to address the pressing issues facing nursing today. These issues include the implementation of innovative technology, attention to health equity, and preparing leaders to serve public and population health care delivery systems.⁵

One significant recruitment challenge is that nurse faculty salaries are lower, with a starting average wage gap of $20 000 annually, when compared with clinical and private sector positions.⁶ For recent graduates, salary gaps further widen due to additional graduate degree requirements for most academic positions and the associated student loan burden. Subsequently, academic preparation for nurse faculty roles may be delayed, with nurses earning a doctoral degree on average 13 years later than in other fields.⁷

A second challenge to nurse faculty recruitment and retention is that curricular content within doctoral nursing programs lacks a focus on the role of nurses as educators.⁸ Despite one in 4 nurse faculty members having an earned doctoral degree, faculty often receive little preparation in the principles of teaching and learning, leaving them inadequately prepared for an academic appointment.^1,9 Evidence suggests this lack of preparation may result in high levels of stress and attrition of early-career faculty.^10,11

A third challenge facing nurses (both registered nurses [RNs] and advanced practice registered nurses [APRNs]) entering an academic environment early in their career is the need to continue development of clinical expertise while assuming teaching, scholarship, and service duties. Positions that do not incorporate clinical practice into the academic appointment and promotion may prevent early-career faculty from transitioning into a full-time appointment. Furthermore, retirement of seasoned nurse faculty creates shortages of skilled faculty mentors for new faculty, which subsequently may reduce confidence in nurses assuming academic roles early in their careers.¹¹

A fourth challenge facing academia is the urgency to teach new skills demanded by a contemporary health care environment, skills that both new and seasoned educators may not possess. The American Association of Colleges of Nursing (AACN) Essentials⁵ identify competencies and concepts that the future nursing workforce needs, specifically encompassing social justice, ambulatory care, primary care, person-centered care, population health, and system-based practice to coordinate resources to provide equitable care. Academic-practice partnerships, the underpinning of faculty practice programs, are an important strategy to provide clinical learning experiences to students within 2 AACN spheres of care as described in the 2021 Essentials—disease prevention/wellness promotion and chronic disease care—while also helping recruit and retain nurses and achieve educational and career advancement.⁵ The COVID-19 pandemic highlighted the necessity of having a faculty in clinical practice prepared to pivot to alternative roles and create health care equity for populations made vulnerable by societal forces.

This article describes one College of Nursing Faculty Practice (CON FP) model—a successful, reproducible, and robust faculty practice program that addresses each of these important areas. The model also enhances a college's ability to build a strong early-career nurse faculty workforce with the right skills to address current trends.

Faculty Practice

“Faculty practice” is a generic term used to describe the clinical practice work in which nursing faculty engage. It is not a new model to nursing academia but one that nursing has found challenging to implement mainly due to payment structures and delivery models of nursing education. Unlike colleges of medicine, which are always affiliated with groups of practicing physicians and payment structures that support medical education, such as the Graduate Medical Education fund,¹² nurses in academia typically need to seek an additional employer to maintain a clinical practice. Saxe et al defined faculty practice as “a formal arrangement between a school of nursing/academic health center and a clinical facility/enterprise/entity that simultaneously meets the service needs of clients, while meeting the teaching, practice, service and research needs of faculty and students.”^13(p1)

Faculty practice programs enable faculty to meet professional licensure and certification requirements and keep current with the most recent evidence-based practice guidelines and models of care. These programs also contribute to the education and professional development of nursing students and to the overall external community engagement mission of the college.¹⁴ In this way, faculty practice is a pathway to student clinical placement, student projects, and research and scholarship opportunities and, in our experience, exposes both faculty and students to nontraditional health care delivery models. Another benefit is that students who had a learning experience in a faculty practice site may also seek employment postgraduation in the faculty practice program, thus setting newly graduated clinicians on a faculty career path. Evans¹¹ found that two-thirds of nurse educators decided to enter academia because they were positively influenced by a faculty role model. Through faculty practice, clinicians work with both practicing nurses and students and can serve as role models to increase faculty recruitment rates.

Colleges and schools of nursing operationalize faculty practice in many ways, but most faculty practice programs can be loosely organized into 3 general categories. First is a formalized administrative structure for faculty clinicians engaging in practice sites that are formal partners of the school and whereby faculty clinician practice time is protected by being integrated into their full workload. Second is a structure in which practice sites are not formal school of nursing partners, but faculty receive some degree of protected time from teaching for clinical practice. In the third structure, faculty engage in practice independent from their teaching role. In addition to structural variations in faculty practice settings, the types of practice engaged in by faculty vary widely across the country. Types of practice might include faculty who engage in direct patient care across traditional inpatient or outpatient settings, nurse-managed clinics, clinical consultation, volunteerism, or advocacy efforts.

It is common for US colleges of nursing to incorporate some element of clinical practice or community service in their mission and vision. However, a 2018 analysis of publicly available website data for the top 50 nursing schools from the 2016 Best Nursing Schools list¹⁵ for both the doctor of nursing practice (DNP) and master of science in nursing (MSN) programs revealed that approximately 30% of schools do not indicate a faculty practice program on their website.¹⁶ This indicates a gap in formal faculty practice programs, despite faculty practice being a recommendation in the National Taskforce Criteria for Evaluation of Nurse Practitioner Programs¹⁷ and an evaluation metric often used in school accreditation.^18–20 As more schools consider or develop faculty practice programs, more opportunities become available to leverage faculty practice programs for early-career faculty pipeline development.

College of Nursing Faculty Practice Model

The CON FP model was established in the 1970s and is historically known synonymously as the Teacher-Practitioner Model. Within this model, nursing faculty fully integrate practice, education, and scholarship into their faculty role. The current CON FP model was reimagined and established in 2014 (see Supplemental Digital Content, Figure 1, available at: https://links.lww.com/NE/B90). One of the earliest steps of the redesign was the creation and vetting of a new mission and vision. The mission of the CON FP is to provide practice opportunities for the integration of education, research, and clinical practice to advance faculty in their clinical field of expertise and to provide measurable health benefits and solutions for the populations served. The vision is to be a center of innovation for nurse-managed care delivery models while meeting the needs of underserved communities and populations made vulnerable by systemic racism and other social injustices.

The strategic redesign included drafting and vetting of a 5-year business plan including specific, measurable, attainable, realistic, timely (SMART) goals. An administrative team was then constructed to strategically support the college's mission and vision and is organized under the Assistant Dean of Faculty Practice and supported by a full-time Business Director and a full-time Program Manager and Data Analyst. Every site agreement includes a requirement for student placements. A strategic push was made to hire new graduate RNs and APRNs who might not be “ready” for a faculty role but who have an interest in academia. In addition, student learning opportunities and faculty clinician scholarship expectations were clarified and are expected across the entire practice. Practice opportunities were opened to RN-licensed faculty in addition to the APRN-licensed faculty.

Flexibility is a key component for sustaining the CON FP model, meeting academic teaching needs, and supporting early-career faculty. The needs of partner agencies often fluctuate, creating salary challenges when funding is lost and the need for additional faculty effort when an agency's needs increase. The varying needs of early-career faculty can include additional clinical experience (eg, a new APRN with a DNP degree) as well as the intense mentoring required of all new academic faculty members. Academic teaching needs fluctuate with course enrollments, faculty getting buyouts of teaching time via grant funding, and faculty attrition, most recently attributed predominantly to retirements. The CON FP model addresses all these challenges. The Assistant Dean of Faculty Practice works closely with the CON Department Chairpersons to create individual faculty workload allocations that meet the needs of both CON FP and overall college teaching needs.

There are 2 CON FP hiring models (see Supplemental Digital Content, Table, available at: https://links.lww.com/NE/B91). The first model is for the hiring of traditional faculty with a practice-dedicated workload. Traditional faculty are primary direct reports to the Department Chairpersons, with a secondary reporting to the Assistant Dean of Faculty Practice. The second model is for CON FP clinicians who directly report to the Assistant Dean of Faculty Practice. This second model is particularly well-suited to recent APRN or RN graduates with an MSN, DNP, or PhD degree who want an academic career but lack advanced clinical experience. Anyone working for CON FP is expected to precept students, facilitate both MSN and DNP projects, engage in clinical scholarship, and mentor colleagues as a part of their CON FP role.

Benefits and Outcomes

More than 50 RN and APRN CON FP clinicians participate in the program, representing approximately 35 total full-time equivalents (FTEs). Of the CON FP clinicians, 76% teach classes or precept students, and of those, 21% are in traditional faculty roles. More than half (57%) of CON FP clinicians began as early-career faculty recruits and have been retained for 3 or more years; 24% have been retained for more than 5 years. These clinicians provide more than 75 000 annual hours of direct nursing services. Students benefit from the CON FP program as well through the integration of learning opportunities in academic-practice settings. Currently, there are more than 20 DNP student projects, 15 prelicensure MSN capstone projects, and more than 25 000 precepted direct student clinical hours completed annually across our faculty practice sites. The practice supports more than 15 interdisciplinary federal work-study students who contribute to on-site administrative needs as well as ongoing outcome evaluation data collection.

The practice also serves as a pipeline and mentorship program for new graduates. To date, 25 student alumni representing 32.9% of the current CON FP clinician workforce have been hired by CON FP (RN and APRN) for their first professional nursing job postgraduation. This work is done across more than 30 academic-practice partnerships and reflects a more than 650% growth in revenue since the 2014 redesign. Supplemental Digital Content, Figure 2 (available at: https://links.lww.com/NE/B92) provides a diagram of CON FP benefits.

Recruitment and Retention

Department Chairpersons investigate prospective faculty interest in incorporating practice into their formal faculty role. If candidates express interest, the Assistant Dean of Faculty Practice meets with every CON faculty candidate, with practice as a professional goal. In addition, as faculty roles evolve over time, Department Chairpersons revisit FP as an option. Many new faculty members start in practice roles immediately upon hire, whereas others rotate in and out of the practice across time. In regard to recruitment, we have received feedback from new faculty that the CON FP program was a reason for accepting a position with the school.

Several factors contribute to high satisfaction and retention in the practice. When surveyed, 75% of CON FP clinicians responded that they are very satisfied with the available career development opportunities and 100% agreed they were encouraged to come up with innovative ways of accomplishing work. All CON FP clinicians stated that they are proud of their work and are making a difference in people's lives. Within the CON FP program, there is a high clinician retention rate, with less than 10% attrition since the operational redesign. CON FP clinicians function at the fullest extent of their education and training. There is a convergence of scholarship and clinical practice, where conversely those who are in one full-time position may only experience one or the other. This allows for progress in a dynamic clinical position even when the practice is part-time. In addition, with a seamless integration of faculty and clinical roles, all income, insurance, and benefit details are housed with a single employer.

Scholarship

It is a clearly defined expectation that all CON FP clinicians contribute to student scholarly activities, such as MSN Capstone and DNP Project development, and to their own scholarship commensurate with their rank and as defined by the AACN Scholarship of Practice.²¹ Students and faculty clinicians produce, on average, 20 to 25 national peer-reviewed posters, podium presentations, public thought pieces, and/or manuscripts annually, representing their scholarly work at CON FP sites. In this way, faculty clinicians mentor future nursing scholars and meet their own faculty scholarship goals simultaneously. Each of these activities contributes to faculty promotion opportunities and, importantly, to production of new evidence-based data to guide and inform practice and teaching.

Work-Life Balance

Philosophically, making the transition from clinical practice to academia and balancing both roles can cause strain while moving from novice to expert in a new position. It is suggested this role strain emanates from a conflict between familiar expectations as a clinician adjusts to new demands associated with faculty life.²² A position with CON FP eases this strain, allowing for many facets of an enriching career to be woven together into one position. CON FP clinicians have protected time for various pursuits in alignment with the CON's mission encompassing practice, education, research, and academic-practice partnerships.

Logistically, work-life balance can be greatly affected when faculty have a second employer for their clinical practice.²³ Faculty working for 2 employers report issues related to calendar alignment, where vacations and recognized holidays may differ, and requests for paid time off or sick time must be made to both organizations and policies may not align. Administrative expectations such as competency training and credentialing paperwork are often duplicative and inefficient when they must be done for 2 separate employers. Also, working for 2 entities part-time affects vestment and impacts retirement benefits and planning. Faculty practice with protected time to balance patients' and students' needs is a solution to these problems, thus positively impacting work-life balance.

Mentorship

Mentoring is a primary strategy to establish both healthy work environments and to facilitate the ongoing career development of nursing faculty.^9,24–27 The CON FP mentoring program is intentional and organized strategically within the CON. By design, CON FP provides built-in mentorship structures that allow early-career educators to be advised by and collaborate with mentors and peers across focus areas of community-oriented nursing practice, scholarship, and education. When a CON FP clinician expresses interest in teaching a course, a course mentor is assigned, and the course mentor is provided workload credit to mentor a first-time educator. If a CON FP clinician transitions to a traditional faculty role, a teaching and/or research mentor is assigned in addition to the course mentors.

Challenges

This successful model is not without its challenges. Despite structured orientation and mentorship, academic acculturation for CON FP clinicians is a large learning curve. For example, it often takes years to develop an understanding of rank appointment meaning and process. Also, the role necessitates an ability to shift from a clinical mindset to a teaching mindset often within the same day or week, which is a skill that takes time, patience, and support to develop. From a leadership perspective, adjusting teaching workloads to accommodate changing practice work allocation can be challenging. Schedule conflicts can occur between practice obligations and faculty activities such as department meetings. This problem has partly been addressed with the move to recorded, asynchronous, and virtual meetings during the COVID-19 pandemic.

Faculty Practice Exemplar

The CON FP clinic is a nurse-managed primary care health and wellness clinic located on affordable housing premises and is available to all residents in an affordable housing community. The Center, opened in 2015 by CON FP, serves as just one exemplar for the development of early-career faculty. While growing their new APRN skills, early-career faculty also gain firsthand exposure to a successful model of primary care/population health nursing care that prioritizes racial and social justice issues and other social determinants of health within the context of wellness, health promotion, and chronic disease care. At the Center, faculty split their total CON workload between practice and other academic activities, typically 20% to 50% time for practice, with the remaining time designated for teaching and other academic responsibilities, thus making the faculty clinician full-time from an employment perspective. In addition to providing direct care to patients, faculty clinicians work directly with students and facilitate student projects as part of their overall practice role at the Center.

To date, the Center has provided 4 early-career APRNs the opportunity to grow their clinical practice skills in conjunction with their academic role. One of the 4 APRNs was unique in being a seasoned educator who returned to school to earn a DNP degree and APRN licensure and thus it was critically important for them to have an outlet for clinical practice while retaining their teaching and other academic activities. The other 3 were new APRNs and educators, requiring mentorship in both clinical practice and academic nursing. Collaboration between the CON FP and the CON Department Chairpersons, with input from each faculty member, produced a workload balancing clinical practice, teaching, scholarship, and service.

Feedback of CON FP clinicians on this balanced workload with intentional mentoring is positive, and they felt they were able to grow professionally while being supported clinically. The Center provided them a built-in opportunity for faculty scholarship; it is a real-life laboratory for academic areas of inquiry development. Since its founding, the Center has inspired and served as a springboard for more than 20 scholarly presentations and publications. The clinicians speak highly of and appreciate the practice autonomy, flexibility, and work-life balance. To them, faculty practice means not having to choose between an academic and clinical practice career path but pursuing both in a fulfilling way simultaneously.

Summary

Mounting nursing shortages, perpetuated by parallel faculty shortages, threaten to adversely impact patient safety and reduce the health care system's ability to adequately address patient needs. In combination with pending retirements, burnout of nurse educators may have devastating trickle-down effects on the available supply of clinical nurses at every educational and practice level. CON FP is a promising model for developing early-career faculty. The model allows continued growth in clinical practice including exposure to contemporary nursing competencies. By working closely with all CON leadership, CON FP clinician and faculty workloads are coordinated and a pipeline of potential new faculty is both recognized and developed with intentional mentoring. We offer this early-career faculty practice pipeline model as a solution for attracting and growing contemporary nursing faculty workforces.