A foot in two camps: An exploratory study of nurse leaders in universities
Introduction
The position of nursing as an academic discipline has had a contested history. While the first Bachelors degree in Nursing was offered by the University of Minnesota in 1909, it was another fifty years before Edinburgh University launched an integrated degree in nursing in 1965 and in 1971 established the first Chair in Nursing in the United Kingdom (UK) and in Europe. These significant developments came about through the efforts of many, such as the first Director of Nursing, Elsie Stephenson (Allen, 1990) and academic champions outside nursing. At that time the Dean of the Faculty of Arts at Edinburgh University was the eminent moral philosopher Professor John Macmurray. He argued that nursing, like education and medicine, is a profession grounded in a personal relationship and that the quality of the patient experience would be improved by nurses with degrees and skills in reflective practice. He saw himself as the “godfather to the Nursing Studies Unit at its birth and during its earliest years” (113) and was fiercely proud of its achievements as it established itself as a practice discipline in the university (Costello, 2002).
Following Edinburgh University's lead a handful of Russell Group universities established nursing degree courses in the seventies such as Manchester, King's College London and Southampton, but it was not until the 1990s following market-led reforms, introduction of the purchaser provider split and employer-led commissioning outlined in Working Paper 10 (Department of Health (DH), 1989) alongside Project 2000 (United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986), that the mass move of nurse education from the NHS to universities was achieved (Burke, 2003, Burke, 2006). In 2012 there were 67 education providers (mostly universities) in the UK offering nursing programmes through contracts with the NHS. The expansion of student numbers in the nineties in response to acute workforce shortages has meant that the income from these contracts for mainly diploma routes to nurse qualification has been significant for the higher education sector. The move to all degree programmes has been slow with England (now due to implement fully by 2013) following behind the 3 other countries in the UK, and Scandinavia and North America.
The rapid expansion and fundamental reforms of nursing education has inevitably meant that universities have developed academic structures with new academic leadership roles for nursing, which are often, but not exclusively occupied by nurses. Despite this growth, Meerabeau (2005) notes that the place of nursing within the academy is largely invisible, which is borne out by the lack of literature on academic leadership. There are a few exceptions to this, for example, Salminen et al. (2010) addressed the leadership challenges of harmonising nursing education across Europe, Rafferty and Traynor (2004) explored research leadership and the United Kingdom Clinical Research Collaboration (2007) explored the development of new clinical/academic career pathways. The paucity of attention to academic nursing leadership in the literature is an interesting contrast to the growing preoccupation with nursing clinical leadership, which is often considered a key component for quality and safety in England (Department of Health, 2010, Wong and Cummings, 2007).
It is timely then to consider the nature of leadership of nursing within higher education, especially given the size and complexity of the job to manage large education contracts, lead research, build and sustain employer relationships as well as to address external drivers facing universities such as funding, quality, social mobility and technology (Coffait, 2011). This paper reports on a study that explored the scope and meaning of leadership from the experience of nurse leaders in universities across the United Kingdom (UK).
Section snippets
Background and Literature Review
In the UK nurse education is delivered by universities through contracts with NHS bodies for example Strategic Health Authorities and their successor bodies (Local Education Training Boards from 2013) in England. Employer-led commissioning determines student numbers, which are subject to annual adjustments as workforce requirements change to reflect service need. Contracts are performance managed for quality, outputs and value for money, leaving universities to manage the risk to income,
Method
A convenience sample of nurse leaders were identified through the Council of Deans of Health, which is a UK membership organisation of all universities providing education in nursing, midwifery and allied health professions. From a possible population of 67 education providers of nursing in the UK, informal approaches and invitations to heads/deans to participate were made in person or by email. Written consent was obtained from 11 people who agreed to participate and of these 10 took part in a
Results
All the respondents were managing health care portfolios and running schools/faculties of various sizes — some were managing other professional disciplines, e.g., allied health professionals and social work. Job titles differed (dean/head of faculty/school) depending on the organisational structure of the university. For convenience in this paper we use the term dean to preserve anonymity. Half of the respondents worked in pre 1992 universities (the former polytechnics gained university status
The Leadership Context — Navigating the Different Cultures and Politics of the Professions, Employers and the University
As noted earlier nurse education is delivered through contracts with the health service. It is employer-led and determined by performance, e.g., recruitment, progression, attrition, employment and so forth. As well as meeting these targets, deans are responsible to their employer, the university, for meeting targets for performance on research outputs, student satisfaction, learning and teaching, widening participation and enterprise. The balance of these activities is not surprisingly
Leadership Skills
The second theme emerging from the data was the leadership skills seen by deans as necessary for the job. These were described as multifaceted, as deans struggled to manage complex boundaries and uncertainty, as well as working to sustain their own academic profile within the university. Three aspects came out strongly.
Legitimacy of a Practice Discipline/Nursing in Higher Education
The third and final theme that emerged from the data is the legitimacy of nursing as a practice discipline in universities. Whether or not nurses should have degrees has been disputed for over a century and can be traced back to 1901 and Mrs Bedford Fenwick, a nurse reformer. In establishing the degree in nursing at the University of Edinburgh 56 years later, Elsie Stephenson was challenging a “sacred cow” — the belief that nursing was purely a vocation, which does not need a degree. She
Discussion
Although this was a small study and a snap shot in time, it illuminates how nurse academic leaders make sense of their complex roles. The participants were generous with their time and frank in their responses to the open ended questions, which took a “conversational” form allowing for depth exploration of views. Only interviewing one participant from London, due to the competitive tender, may have been a limitation, although in our view reducing the possibility of a London centric bias can
The University as a Knowledge Producer
Gibbons et al. (1994) have distinguished universities as producers of knowledge between Mode 1, defined by traditional scientific practice, unidisciplinary, formal structures based on authority and hierarchies, contrasted to Mode 2 knowledge, which is typically problem focused and is “legitimised by its utility in application” (Ternouth, 2012). The practice discipline of nursing seems to fit with the Mode 2 communities, which commonly crosses organisational boundaries and creates knowledge in
Academic and Professional Identities
The second issue relates to the fundamental dichotomy between the university and practice, which sets up tensions between the dual identities (academic and professional) experienced by the nurse leaders, who feel they have a “foot in both camps”. The challenge of developing the personal academic identity for nurse educators has been described by Duffy (2012) and supports the wider higher education literature and is a good example of the expansion of academic identities as universities diversify
Contributors and Acknowledgements
This paper is based on the Elsie Stephenson Memorial Lecture given by Professor Fiona Ross at Edinburgh University in March 2012. Di Marks Maran carried out the interviews and analysis. All authors contributed to interrogating the data in relation to the literature, provided insights to the analysis and were involved in drafting the paper.
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