International Journal of Nurse Practitioner Educators

You don’t know where you’re going until you get there: An expository narrative of novice nurse practitioner educators

 

 

You Don’t Know Where You Are Going Till You Get There-An
Expository Narrative of Novice Nurse Practitioner Educators

 

KIMBERLEY LAMARCHE, BEV JUSTIN MULDOON, & LYNN MILLER

 

Abstract
Nurse Practitioner (NP) education in Canada is evolving rapidly as the role gains a foothold in the fabric of health care.  Expectations for existing NP faculty to be clinicians, teachers and researchers, as well as the increasing demand for NP graduates have created challenges and opportunities for inventive ways to expand the cadre of available NP teachers.  The experiences of a group of Master of Nursing (Advanced Nursing Practice) graduates provide an innovative approach to filling this need.  This narrative expository inquiry focuses on the student-to-teacher transition experiences of this group of NP sessional instructors as they transitioned from the student to teacher role in facilitating online NP courses. Their journey evolved into a unique extension of the student role; not only did the participants survive their student days and the transition from registered nurse to nurse practitioner, but they also made the shift to instructor and partnered as novice researchers shortly thereafter. Themes arising from the narratives reveal implications for NP distance education programs and future NPs who aspire to make the jump from NP student to graduate instructor.

 


N

urse Practitioner (NP) education in Canada is evolving rapidly as the role gains a foothold in the fabric of health care.  Faculty and administrators have been under increased pressure to become researchers as well as teachers. This emphasis on research has motivated the development of faculty research committees and other strategies to involve more front line teachers in research activities. Within NP programs, the demand for current clinical skills in addition to traditional research and education competency presents a challenge.  These institutions require skilled professionals who practice, teach and conduct original research. Challenges exist in finding qualified individuals with preparation in both nursing education and the NP role; thus creating a need for innovative approaches to filling these positions.

This project set out to examine the experiences of recent Master of Nursing (Advanced Nursing Practice) graduates as they transitioned from the student to teacher role in facilitating online NP courses. Their journey evolved into a unique extension of the student role; not only did the participants survive their student days and the transition from registered nurse to nurse practitioner, but they also made the shift to instructor and partnered as novice researchers shortly thereafter. This narrative expository inquiry focuses on the student-to-teacher transition experiences of these NP sessional instructors; revealing implications for NP distance education programs and future NPs who aspire to make the jump from NP student to graduate instructor.

 

 

Background

In Canada, the Masters prepared NP is an evolving role. According to the Canadian Nurses Association (2011a), legislation supporting NP practice now exists in all provinces and territories.  Newly published data show that NP numbers have more than doubled over five years, including a 25% jump in a single year.  By the end of 2010, there were 2,486 NPs practicing in Canada, up from 1,129 in 2006 and NPs now represent 0.7% of the total registered nursing workforce (Canadian Institute for Health Information [CIHI], 2010).

 NP distance education programs were created across the country, attracting Registered Nurses (RNs) eager for the challenge and professional growth that this new role could offer. The Canadian Nurse Practitioner Initiative (CNPI) was implemented over 18 months from 2004 to 2006. It made significant progress in establishing legislation, promoting educational requirements and defining and promoting the NP role (CNA, 2009).  In 2006 the Canadian Nurses Association (CNA) identified a shortage of Masters and Doctoral prepared NPs to take on educational roles (CNA, 2006), and called for creative strategies to address this need. In the 2011 Integration Plan for the Nurse Practitioner Role (CNA, 2011b) a key goal was to ensure that “doctorally-prepared and masters-prepared NPs teach in NP programs and/or use teaching or shared resource models” (p. 6).  The potential impact of this identified shortage was recognized by the university prior to the publication of these guidelines, and although instructor compliment for the NP program was being met at the time; the university chose to look to the future and initiated a unique recruitment scheme built upon a ‘grow your own’ initiative (Hessler & Ritchie, 2006). This afforded the opportunity to balance the supply of qualified instructors with the demand of an ever-increasing student population.

The online program functioned with a core group of full time faculty members who worked collaboratively with members of the NP and medical community as sessional or part time instructors. These sessional instructors or course facilitators worked full time outside of the university, usually in clinical settings and provided their clinical expertise and real life experiences to the students. Full time university faculty had the responsibility of course development, standards, and evaluation; the sessionals then delivered this content in small group settings asynchronously online.  At the time of recruitment for this project, it was felt that the cadre of sessional instructors would better serve the student population if it comprised a larger portion of currently practicing NPs as opposed to physicians and/or PhD prepared registered nurses (RN) without formal NP training or current NP experience.  To that end, a select group of recent MN:NP graduates were invited to join the teaching compliment with short term sessional instructor contracts.

In some cases this invitation was through an open call in the final practicum course and in others it was targeted recruitment after graduation. In all cases, these prospective sessional instructors had been exemplary students who had demonstrated above average integration of the theoretical and clinical material mastered throughout their program. Those accepted as instructors had all demonstrated mastery of the RN role, met current entry to practice standards for NP licensure, and were actively engaged in NP practice. This approach offered a unique opportunity for these recent graduates to be part of a team that would nurture the next generation of NPs in Canada, while reinforcing the strength of the curriculum delivered. For the small group who undertook this challenge, the transition from student to instructor marked an important milestone in their professional development.

Literature Review

Benner’s sentinel work conceptualizing the evolution from novice to expert constituted the theoretical framework for this project (Benner, 1984). Benner posits that each time a nurse encountered a new role or environment; they are “born again” when moving from novice to expert. In other words, nurses do not graduate as experts. This vision is coupled with descriptive milestones or domains of practice through which nurses pass as they develop in their role; specifically novice, advanced beginner, competent, proficient and expert (Benner 2004).  While Benner’s original work targeted RNs, these five stages can apply equally to the NP role and speak to its philosophical grounding within nursing.  Yerger Huffstutler and Varnell (2006) go on to acknowledge the process of transition from RN to NP, and suggest that while RN experience has created their professional persona and cannot be overlooked, this RN expertise does not translate immediately to expertise as an NP.  This is applicable across the domains of clinical practice and education, and speaks to the dual transitional journey being examined.

There is little existing research specific to this particular mode of NP role evolution, which most certainly contributes to the age of many available references found in searching CINAHL, Medline and PubMed. Numerous publications discuss the experience of new faculty (Murray, Belgrave & Robinson, 2006; Beres, 2006). Hessler and Ritchie (2006) report strategies to recruit and retain new faculty, however the article does not provide sound research to back up the recommendations. In terms of specific NP education, Amella, Brown, Resnick and Behler McArthur (2001) published a descriptive study meant to increase the understanding of the US national trends in NP clinical education.

The online environment was examined in numerous studies (Conrad, 2004; McKenzie, Mims, Bennett & Waugh, 2000; Wilson, Varnhagan, Krupa, Kasprzak, Hunting, & Taylor, 2003; Owston & Wideman, 2002). Online instruction themes related to quality of discussion, changes in teaching styles, time issues, attitudes to online learning and influences of online learning on classroom teaching.

Certain published academic studies presented clear frameworks or recommendations for new faculty integration. Glanville and Porche (2000) describe a faculty development framework that ensures success of minority graduate faculty in the academic roles of educator, nurse scholar, service provider, and community leader.

Few relevant role transition articles were found. Heitz, Steiner, & Burman (2004) examined the role transition that occurs in family NP students and Esper (1995) explored the transition from nurse clinician to nurse educator. A descriptive study by Siler and Kleiner (2001) examining the expectations of novice faculty in their first year of teaching revealed four common themes: expectations, learning the game, being mentored, and fitting in.  

Methodology

Historically, storytelling has been a way of capturing and exchanging information and knowledge within nursing and society as a whole (Redman, 2005). The interpretation of stories is a powerful source of often hidden or undiscovered knowledge and can influence actions, opinions and the individuals’ perceptions of themselves and others; while spawning personal and professional growth (Moen, 2006; Serrant-Green, 2006). “Telling narratives is a major way that individuals make sense of disruptive events in their lives” (Riessman, 1990, p. 1199).  In addition, reflection can strengthen decision-making and coping strategies through practice (Sewell, 2008), and speaks directly to Benner’s model by giving the new NP experiences to share with his or her peers and seasoned nurses. 

Narrative research, part of the qualitative genre, represents phenomena of interest along with analysis for common themes and interpretation of experiences (Klein & Janoff-Bulman, 1996; McQueen & Zimmerman, 2006). An inductive expository narrative research approach was chosen to explore the experiences of these sessional NP instructors as they made the transition from student to teacher, as it best captured the rich themes that sprung from their shared stories. The aims of this narrative are to identify and describe the lived experiences of the student to teacher transition. In the past decade narrative inquiry has manifested itself as a more recognized domain in the qualitative traditions of health research (Lapume, 2009).

Research Team

A faculty research committee activity called ‘collaborative research group’, offered an invitation to sessional or contract instructors to join with fulltime continuing faculty in inductive research development. The goal of this group was to build research capacity within fulltime educators as well as contracted sessional or part time instructors.  To that end, the group comprised four novice NP sessional instructors, two full time continuing faculty members, and one sessional non-NP qualitative research resource person.  One continuing faculty was the NP program manager as well as a practicing NP, one was the research coordinator for the faculty and provided process expertise, and the sessional instructor with recognized expertise in qualitative research methods was invited to join the group when the direction of the narration began to take shape to assist with coding and themes.

Participants

 A sample of four novice NP sessional instructors was purposefully selected to participate as narrators in the inquiry.  This ensured that participants had ample rich data to contribute in describing the experiences of novice NPs transitioning to the teaching role.  Secondly, it was important that participants had past nursing experience within which to frame their responses (Benner, 2004).  In addition, recent experience in the program would ensure that they were aware of the content in order to facilitate course delivery. Finally, the group felt it was important to explore the program’s unique online mode of delivery and its influence on their transition from student to teacher.  Inclusion criteria appear in Table 1.

 

Table 1. Inclusion Criteria

1.   Meeting our definition of novice as any instructor that had less than two years part time or six months full
               time experience teaching at the NP level.

2.   Hired to facilitate a group of online learners within six months of their graduation from the university’s NP
               program.

3.   Experienced nurses with more than 15 years as a RN prior to entering the NP program.

4.   No previous experience in graduate teaching

5.   No previous experience as an instructor in online education

 

All participants had completed their graduate program within the last six months in the top 10% of their class.  Between them, they brought a wealth of over 90 years of nursing experience, in the clinical, administrative and classroom settings.  Although the experience and education mix differed with all involved, the constants among all narrators were the direct transition from graduate student to teacher, the passion for the NP role and the belief that a strong education foundation is essential for practice. One narrator correctly summarized one of the most important attributes of the selected narrators in stating: “I think she (the program manager) saw passion and interest in people and the profession, which is what I think I bring to this role.”

 

Data Generation and Management

Participation in the research group was voluntary and in no way tied to the instructor’s employment with the University.  Consent was confirmed by participation and could be withdrawn at any time. The group initially met on a regular basis via teleconference to discuss the research process, to develop inclusion criteria and plan for data management.  Although the outcome of the narrative inquiry was paramount, important also was the development of research skills within the NP faculty.

Initial requests to generate data were focused upon capturing narrator’s stories and understanding their transition experience.  To that end, participant data was generated independently of one another in a web based format. There was no direction other than “let’s tell it like it is”.  Participants recorded the narrative accounts of their experiences and feelings as they transitioned from NP student to NP teacher.

Once all narrators had produced an initial product, they were then asked to redirect their writing into themes. Themes which emerged included the feeling of fear when assigning first marks, the imposter phenomenon when placed in their first course and the enriching nature of teaching when applied to their clinical practice.  Once each narrator had completed this step, the group met to examine the initial data.  Interestingly the similarities were overwhelming. Although the narrators had not discussed their writings with each other during the process, their feelings were mirrored in their colleagues identified themes. The outcome of successful graduate instructors had been produced in all participants by apparently following the same paths.

Data Analysis

As is common practice in qualitative research, thematic analysis was used to identify common concepts from the data. Following the initial data generation and resultant narratives, an independent full time faculty member created themes to guide analysis. Data analysis focuses on how the narrators assign meaning to their stories, while considering the context and past experience from which the accounts cannot and should not be separated (Moen, 2006).

The analysis concentrated on exploring the project aims.  This approach is especially suited to nursing as it encourages nurses to “explore, emphasize but most of all give voice to the subjects of research” (Serrant-Green, 2006, p.3). In this situation, new knowledge was generated through the sharing and analysis of the participants’ separate transition experiences. Coding was initially used only for the purpose of placing the various narrative aspects into themes.

Several themes arose from analysis of the narrative accounts submitted by the four participants. Non-narrative participants in the project placed all the data into general categories.  These themes were developed by the entire research team as it was felt they best reflected the narratives and experiences presented. Interwoven through all narratives were four threads: accepting the challenge, assuming responsibility, sessional growth, and to teach is to learn again. 

Common Threads from the Narratives

Accepting the Challenge

For the narrators, the first step in making the role transition from NP student to NP teacher involved accepting the challenge of the position, an exercise which triggered a flood of introspection and excitement. All narrators described initial feelings of inadequacy and self-doubt that changed to excitement and apprehension with the offer of a sessional instructor position. They shared a sense of homecoming; a return to a familiar environment but on a different footing. The first small leap had been taken!

 

Table 2. Accepting the Challenge

Participant A

Why me? I am a graduate, but I haven’t walked across that stage yet! I was flattered,

excited and, to tell you the truth honoured to be approached. My goodness, I’m thinking this will be
         uncomfortable, and, whom? Oh well, I’m up for it. I am going to respond to the offer with pride and

not worry about the small stuff.”

 

Participant B

 I glanced at the offer and thought that looks interesting. I knew I was a very dedicated student
        with good marks but not the top of the class. When the interview was complete the manager said “You have
        been a student with us for 3 ½ years we know you well. Welcome!” I had started the journey from student to
        instructor.

 

Participant C

I was thrilled and frightened when the offer came for a sessional instructor position.

I was suffering a bit of anticipatory separation anxiety…graduation was looming and I could not see

being disconnected from my academic “family”. I inquired why I was given the honor of this job and I

was told that I would figure it out as I began to teach…

 

Participant D

 I have been practicing as a primary health care nurse practitioner in Ontario since 1999.

 I completed the Master of Nursing program in the spring and began a role as a sessional instructor

in September of that same year.  Prior to taking on this role, I had just less than two years of

part time experience as a sessional instructor in the post-graduate NP program in Ontario. 

 

The Awesome Responsibility

Making the role change provided an eye-opening view from “the other side of the fence”! The instructor role carries a sense of responsibility for student outcomes. After all, the students’ dreams and career aspirations were contingent upon achieving passing grades! In the traditional bricks and mortar education system, students are socialized to believe that the teacher is the expert. As new instructors, narrators noted it was sometimes difficult to present themselves as established experts despite their credentials.    As new NPs themselves, they repeatedly stated that the responsibility for future clients of the graduate NP students rested heavily on their minds. The NP who engages in self-reflection, the act of calmly looking inward or giving attentive meditation to a subject, will work through the transitional process more effectively, as opposed to spending time on fears or denying one’s limitations (Yerger Huffstutler & Varnell, 2009). Another repeating theme was empathy for the students, given the narrators’ recent status as students themselves. They noted that it was not unusual to agonize over poorly written papers, even to the point of practically rewriting them; and returning that first failing grade was described as “sickening”. One of the hardest lessons for any instructor to learn is that the teacher does not fail the student; rather the student fails themselves.

 

Table 3. The Awesome Responsibility

Participant A

It’s not about me anymore, it’s about them. I just opened an e-mail and the student is quite vocal

about what she thought she should make for a mark on the first assignment. I must say, I feel

intimidated…I even start to second guess my marking. This is so strange for me because I am a leader,

I am confident and I love to teach. It’s not like me to second guess what I do and that bothers me. I

think it is because I am so new in so many roles at the same time, I really do.

 

Participant B

 I was surprised at the work load. The most difficult part of the role was marking

papers that were poorly written which happened with the very first paper I had to mark. I felt sick!

I did not want to fail my first paper. Could I be wrong?

 

Participant C

 My goal was to lead and facilitate without disrespecting, condescending, nagging or sounding

like Charlie Brown’s school teacher! Challenges were numerous: marking my first assignment and

 failing my first student! I felt a great responsibility for the outcomes of these students, even though

 I know they are responsible for their own efforts. My role impacted their career aspirations…their

 dreams…to a great extent, and when I placed myself in their shoes (which I had only recently left);

I could understand their feelings, fears and frustrations.

 

Participant D

 I had several years of experience in marking papers. Even so, I initially had anxiety

in sending back a failing grade or low mark. I was caught up in the feeling that I wanted everyone to

like me and was unsure of the expectations with respect to the amount of leniency I should give. I do

not feel that I compromised the integrity of the assessments that I made, but it did take some time for

me to feel comfortable hitting that “send” key.

 

 

Fostering Growth

Past experiences as students of the same program proved valuable for the new instructors as they transitioned. Being a graduate of the program helped narrow the experience gap between the student and instructor roles, since the instructors already had an understanding of the course format and content from their own student days. The steep learning curve was supported by a virtual connection among members of the instructor group, similar to the one apparent in the online classroom environment. Over that first semester, a sense of kinship and respect grew between team members that went a long way in nurturing the confidence of the new instructors in their abilities as instructor and practitioner. Instructing and practicing at the same time had beneficial reciprocal relationships; instructing benefitted NP practice and active practice improved the breadth, quality and credibility of the instructor. Their experience and enthusiasm was mixed with knowledge of the format and content of the program and the reality of NP practice. This combination of credential, experience as students, and understanding of the process through mentorship reassured the instructors.

 

Table 4. Fostering Growth

 

Participant A

 I remember being challenged by a student. Feeling uncertain as to next steps, I contacted my

 program manager. I was supported in the decision I had made; and my confidence was on the

uphill climb again.

 

Participant B

 The University suggested that new instructors buddy up with those who had taught before and were

teaching the same course. I found this buddy system very useful as we could talk to each other about

 how we were doing things, get ideas and support each other. It was a definite advantage to have

gone through the course myself…I was able to identify with the students.

 

Participant C

 The instructor role turned me back into a student because I found myself studying right along with

 my class. In addition, the university provided a connection to more experienced instructors; a buddy

system of sorts, that was a wealth of knowledge, time-saving ideas and support that I consider to be

 my most valuable return from that first semester.

 

Participant D

Because I had not completed the clinical components of this program, I quickly discovered that details

 that were clear to the other instructors certainly did not seem clear to me…I relied a great deal on the

 program manager to guide me through those first months until I had a sense of the structure.

 

 

To Teach is to Learn Again

The instructors quickly realized that their new role challenged them to stay abreast of current healthcare evidence as well as familiarize themselves with NP scopes of practice and legislation from multiple jurisdictions in order to effectively respond to their students. In reflecting on this process, one narrator recalled saying, “to teach is to learn again”.  This resulted in the reciprocal understanding of the full breadth and depth of the NP role in Canada and jurisdictions abroad.

 

Table 5. To Teach is to Learn Again

 

Participant A

When I look back to many “firsts” in my professional career, none of them were without fear,

apprehension and challenges. One of my daytime co-workers said to me, “your eyes light up when

you talk about the course your teaching and the student’s progress and what they teach you”.

My response, “I know, I just can’t get enough of it”. At least so I thought. I think it is because I have

a heart to be an educator. I have a passion and now after this first course is under my belt; my

passion is stronger than ever. I remember what it was like to be a student. I didn’t realize the amount

of work on the instructor side…I do now.

 

Participant B

One of the greatest benefits...was the opportunity to keep my education fresh in my mind.

You learn from your students...perhaps through sharing a situation from their clinical that impacts the

care I provide to my patients.

 

Participant C

I think I read the articles and references in a different way than I had as a student two years

prior…if anything, I studied harder as a teacher if that makes sense! It absolutely confirmed that

whole idea that you only really begin to learn when you finish your education! This has grown now to

 a more mature outlook on how to handle all of my various practice roles and for that I am thankful.

 

Participant D

 The difficulties were far overshadowed by my love for the challenge of using the technology,

providing valuable instruction and offering up myself as an example of how a nurse practitioner

could practice. This last feature was especially rewarding as many of the students were studying

without the benefit of witnessing NPs in action. I have found, like anything else in life that the initial

highs and lows of instructing have evened out a bit. However, I love the work as I “mature” into the

role and look forward to continuing for a long time.

 

 

Conclusion

A retrospective narrative of NP instructors as they transition to their first teaching role provided an opportunity for self-reflection on their NP roles, both as clinician and educator, as well as enhanced competency in research.  Mentorship of NP instructors, facilitation of the transition of sessional NP instructors into their clinical practice environment, support for their evolution along the novice to expert continuum, and  a full exploration of all NP competencies have been accomplished in a meaningful and professionally fulfilling way.  Since first sharing their stories that comprised the narratives, all four participants have maintained both clinical practice and educational roles; and credit their passion for excellence in the realms of both clinical practice and education to those early steps on their journey from student to teacher.

 

 

About the Authors  Kimberely Lamarche, RN NP, DNP, is a Primary Health Care Nurse Practitioner at the Canadian Coast Guard College in Sydney, Nova Scotia and is an Assistant Professor with Athabasca University. Contact Dr Lamarche at lamarche@athabascau.ca. Bev Justin Muldoon, RN NP, MN Med, is a Primary Health Care Nurse Practitioner in North Sydney, Nova Scotia and a Sessional Instructor with Athabasca University. Contact Ms Justin Muldoon at muldoobj@hotmail.com. Lynn Miller, RN NP, MN (DNP Student), is a Primary Health Care Nurse Practitioner  in Cumberland County, Nova Scotia and a Sessional Instructor with Athabasca University. Contact Ms Miller at lynnmiller27@gmail.com.

 

 

Key words: nurse practitioner, online education, role transition, narrative inquiry

 

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