February 2011 Issue • Volume 39 • Issue 2

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Teaching—The Second Time Around

by Cynthia Flynn, CNM, PhD,
Currently: General Director, Family Health and Birth Center, Washington, DC
Expert Midwife, pregnancy.org

My first career was as a demographer and statistician, and after teaching sociology at an undergraduate SUNY institution, I was tenured at the University of Kansas. I gave up my tenure to do three years of social science research on the effects of the Three Mile Island Nuclear Plant and to start a research firm of my own. After changing careers twice more, at age 47, I entered the immersion program in nurse-midwifery at Yale University. Upon graduation, I was offered a faculty position to teach both midwifery students and medical residents at another SUNY university. At the time, I felt strongly that in order to teach, I first had to attend at least one birth without a preceptor! I spent the next 10 years in independent solo practice, and also started a free-standing, licensed, nationally accredited birth center. I carried a pager 24/7 and provided full-scope midwifery and well-woman care, as well as care of newborns. Eventually, I was approached again about becoming a member of a university faculty. I felt that the time had come to pass on the knowledge I had gained, and I accepted a position in a college of nursing.

I soon learned that there is a desperate national need for nursing faculty. The Institute of Medicine estimated that by 2010 the United States would be short about a million nurses. Our problem is not that Americans are not interested in becoming nurses; where I taught, there were some 250 qualified applications for 45 places in our "immersion" program. The problem is we lacked classroom space, lab space, clinical sites, AND most of all faculty to accommodate these students. Our Dean expanded the faculty from 37 to 65 in six years, but there was still much more demand for nursing education and demand for qualified nurses by the public than our institution could meet. So why are there not more nurses to teach in colleges and universities?

There is pressure for the faculty in universities to be doctorally prepared, but only a small percentage of the nurses in the United States have PhDs. Many institutions are trying to help address this need by adding a Doctorate of Nursing Practice. In Washington state, some community colleges with master’s prepared faculty expanded to four-year programs to train BSN’s (Bachelor of Science in Nursing) so their graduates could go right into master’s programs from the community college if they wish. This helps relieve pressure on the university faculty to prepare undergraduates. But given the shortage of doctorally-prepared nurses, master’s prepared faculty teach at both the graduate and undergraduate levels. Since those without doctorates are not eligible for tenure, there is de facto stratification of the faculty.

Teaching nursing is extremely demanding. As a sociologist, I worked independently. As long as my course fit the one-paragraph catalog description, I had academic freedom to teach as I saw fit. Nursing is not like that. Of necessity, each graduate is expected to have an extensive core of knowledge, which is determined by nursing accrediting bodies. Both at the graduate and undergraduate levels, students have limited time to take electives in nursing. In fact, the faculty is pressed to assure that all required material is covered in the curriculum within the allotted time frame even if students take no electives. In nursing, achieving consensus and providing oversight of course content requires considerable communication and negotiation among the faculty. I served on many more committees as nursing faculty than I did as a sociologist.

Lectures are different, too. Course assignments for nursing faculty come with PowerPoint presentations prepared and edited by those who previously taught the course, including multi-media inserts and web references. These need to be reviewed and updated each time the courses are taught, of course, but certain material must be covered, and time is short. New faculty must know what is taught—or not taught—in all other courses, and for the whole curriculum to meet its goals.

Unlike sociology, the lecture course is not the conclusion. Nursing faculty need to teach associated lab and clinical courses where students can learn hands-on skills. In lab sections, the teaching is one-on-one; the faculty must assure that every student has each of the skills needed to take care of patients. It is not an option to fail "taking a blood pressure" but to be excellent at "giving an injection" and to have these tests average out to a "C." Once nursing skills are mastered in the lab, nursing faculty need to supervise students’ clinical work, where students see patients in hospitals, clinics, nursing homes, and home settings. Such teaching is very labor intensive, and there is really no way to get the job done other than to have faculty know the capabilities of each and every student in some detail. In addition to teaching on campus, the faculty travel to clinical sites to teach and spend time developing relationships within the community so that those clinical sites will be available for future students. If a faculty member has an emergency or attends a professional meeting and needs to miss clinical, the impact on students is significant; students must still get their clinical hours, another faculty cannot substitute unless they are oriented to that site, credentialed by the institution and available. Covering these logistical problems is not easy.

In sociology, meetings with undergraduate advisees consisted of checking the GPA and ensuring that the student had enough hours to graduate. Even at the graduate level, there was no life-and-death necessity to see that each student had an extensive set of sociology skills determined by a national accrediting body. If a student did poorly, s/he could re-take the course and still progress. In nursing, a poor showing at midterms in a single course can generate an "at-risk" [of being expelled] form.

Nursing students are not socialized to the profession of teaching. When I was a student and teacher of sociology, not all of the teaching was done by the faculty. Even as an undergraduate, with no degree, I earned money by being a teaching assistant. Teaching experience provides students with educational funds, but also socialization into the profession of teaching. In nursing, lab sections of large lecture classes are taught by regular faculty, even at the undergraduate level, which further strains the system. The regular faculty is responsible in a very direct way for all of the teaching—and learning.

Faculty must have excellent clinical skills. In addition to keeping up with the literature, faculty are in practice themselves to keep up their clinical skills and maintain their licenses. My first year, I worked one day a week at a group practice seeing pregnant women and gynecology clients in the clinic. In the summer, while my sociology colleagues were writing scholarly papers, I worked full time doing clinic and on-call attending births. As a nurse-midwife, this means having malpractice insurance beyond that provided by the university, obtaining and maintaining hospital privileges, and having another job with the its complexities. In other words, the job of being a nursing faculty member is more complicated and time-consuming than being a faculty member in sociology, yet it has the same expectations for tenure.

Nursing faculty are in high demand for clinical practice, where compensation is better. A Dean is challenged on a daily basis to recruit and retain good faculty and maintain morale. Prevention of burn-out is a continuing concern; not many nurses have the educational, technical and personal skills, and the motivation to balance the demands of the job(s) with home and family responsibilities. Besides, few nurses entered the profession with the idea of becoming teachers, and they were not taught to teach as part of their nursing education. Unlike sociology students, nursing students know they can get a good-paying job without an advanced degree, and they have many options besides teaching.

Nursing education is serious business. Graduates will be taking care of you and me all too soon. There is a level of stress that was simply not present when I taught in the College of Arts and Sciences; no one would have died if someone failed my Marriage and the Family course but then went on to complete their degree.

So why did I do it? I was thrilled to be back in the classroom with students again! I was amazed and humbled at what students could accomplish in 10 weeks of clinical education. The wonder of "birthing" a competent practitioner is an incredible feeling, well worth all the hard work. My colleagues were great. They truly cared about their students, the College of Nursing, the university, the profession, and me.

But it wasn’t like teaching sociology. So now I am an administrator of an amazing birth center whose motto is to put health care in its social context: www.yourfhbc.org/news.html. On a daily basis, I use my background in organizational development; cultural change—norms, values, and goals; pure and applied research, including data collection and analysis; race relations; conflict resolution; social justice; social problems; medical sociology; and marriage and the family. And sometimes, I still get to catch a baby. logosmall

This article is based on a paper given to the American Association of University Professors, June 12, 2010, Washington, DC

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