Elsevier

Nurse Education Today

Volume 33, Issue 11, November 2013, Pages 1342-1346
Nurse Education Today

A foot in two camps: An exploratory study of nurse leaders in universities

https://doi.org/10.1016/j.nedt.2013.02.008Get rights and content

Summary

Background

Nursing education was fully absorbed into universities in the United Kingdom in the late 1990s and thus is a relatively young academic discipline. In contrast to a lively literature on clinical nursing leadership, little attention has been given to the leadership of academic nursing as these roles encompass contract management, research and teaching.

Objectives

The purpose of this study was to explore the scope and meaning of leadership from the experience of nurse leaders in universities in the United Kingdom (UK).

Design and Methods

The qualitative design used open ended telephone interviews. Interview transcripts were checked with participants. Framework analysis was used for capturing and identifying themes.

Setting and Participants

A convenience sample of academic nurse leaders (responsible for a School, Department or a Faculty) was identified through the UK Council of Deans of Health.

Results

All ten respondents were managing health care portfolios and running departments of various sizes and often with a mix of nursing and other health care disciplines. There was regional and country representation (England, Scotland and Wales) and half the respondents were employed at pre 1992 and half at post 1992 universities (the latter institutions that were previously polytechnics and gained university status in 1992). Three core issues emerged from the data: the leadership context; ways in which the deans articulated their leadership skills and the issue of legitimacy of nursing in higher education.

Conclusion

Two important issues emerged for nursing deans, firstly the university as a knowledge producer and secondly the need to create strong academic and professional identities.

The findings highlight role complexity as academic nurse leaders navigate the dichotomy between the different worlds of the university and health care practice. The legitimacy of nursing as a practice discipline in the university continues to be contested territory. There is an opportunity for nurse leaders to do more to develop a collective narrative about the contribution that academic nursing can make to the quality of the workforce.

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.

References (26)

  • L. Burke

    The process of integration of schools of nursing into higher education

    Nurse Education Today

    (2006)
  • L. Salminen et al.

    Future challenges for nursing education — a European perspective

    Nurse Education Today

    (2010)
  • S. Allen

    Fear Not to Sow — A Life of Elsie Stephenson

    (1990)
  • L. Burke

    Integration into higher education: key implementers' views on why nurse education moved into higher education

    Journal of Advanced Nursing

    (2003)
  • J. Costello

    John Macmurray: A Biography

    (2002)
  • S. Damico et al.

    Seasons of a dean's life: passages for the profession

  • R. Deem

    “New managerialism” and higher education: the management of performance and cultures in universities and the UK

    International Studies in Sociology of Education

    (1998)
  • Department of Health

    Education and training

  • Department of Health

    Front Line Care: Report by the Prime Minister's Commission on the Future of Nursing and Midwifery in England

    (2010)
  • R. Duffy

    Nurse to educator? Academic roles and the formation of personal academic identities

    Nurse Education Today

    (2012)
  • E. Ferlie et al.

    The steering of higher education systems: a public management perspective

    Higher Education

    (2008)
  • M. Gibbons et al.

    The New Production of Knowledge, the Dynamics of Science and Research in Contemporary Societies

    (1994)
  • Cited by (8)

    • Academic nursing leadership: Lessons learned during a pandemic: A qualitative research study

      2023, Nurse Education Today
      Citation Excerpt :

      In addition, nursing faculty note that the pathway to ANL positions is not always clear or well-defined, and institutional support is often insufficient (Adams, 2007). While nursing literature describes challenges faced by nurse leaders within the healthcare environment, similar literature for ANLs is lacking (Ross et al., 2013; Rothwell, 2016). In this paper, we explore experiences of ANLs whose role responsibilities included managing staff, designing and implementing change, engaging in strategic planning and decision-making as well as managing educational crises that arose during the pandemic.

    • Fulfillment in the role of academic nurse leader: A grounded theory study

      2020, Journal of Professional Nursing
      Citation Excerpt :

      Both sectors are male dominated and highly conservative and neither see nursing as a full contributor regarding most public policy regulation and direction (Dowling & Devereaux Melillo, 2015; Redman, 2001). Universities are also patriarchal and have made little effort to challenge the cultural norm of gender relationships (Kenner & Pressler, 2006; Kenner & Pressler, 2009; Redman, 2001; Ross, Marks-Maran, & Tye, 2013). One example of this difference is in a qualitative analysis on the journeys of ten nursing deans.

    • Individual and institutional characteristics associated with short tenures of deanships in academic nursing

      2019, Nursing Outlook
      Citation Excerpt :

      Regarding the impact of institutional culture on the nursing dean role, Bouws (2017) suggested that academic nursing is at a crossroads between higher education and health, both sectors perceived as conservative and dominated by males, which may not fully appreciate nursings' contribution. Similarly, Ross, Marks-Maran, and Tye (2013) raised the issue of the legitimacy of nursing as a practice discipline in higher education, a common challenge to academic nursing leaders in the United Kingdom. In addition, Moore and Porter (1987) discussed the challenge for nursing deans in institutions with a strong focus on liberal arts and sciences.

    • The nursing dean role: An integrative review

      2018, Nursing Education Perspectives
    View all citing articles on Scopus
    View full text