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Faculty mentoring in nurse anesthesia educational programs
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Content
FACULTY MENTORING IN NURSE ANESTHESIA
EDUCATIONAL PROGRAMS
Copyright 2005
by
Dolores Ann Maxey-Gibbs
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for The Degree of
DOCTOR OF PHILOSOPHY
(EDUCATION)
May 2005
Dolores Ann Maxey-Gibbs
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UMI Number: 3180390
Copyright 2005 by
Maxey-Gibbs, Dolores Ann
All rights reserved.
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ii
ACKNOWLEDGMENTS
W ithout the help and support of many individuals, my dream would
have never become a reality. I would like to thank the following individuals
for all their help and support during this endeavor:
Dr. Linda Serra Hagedorn, my advisor, chairperson, and mentor.
Thank you for always taking time for me even on short notice. Thanks for
the numerous hours that you put into this project, and for the guidance and
advice you have always given me regardless of how far away from each
other we were.
Dr. Wynne Waugaman, my committee member, cheerleader,
professional role model and friend. Thank you for all of the hours that you
have spent discussing this project with me, for your advice regarding this
dissertation and life in general. I could not have been able to pursue my
dream if you did not push me along. You are my mentor. Thank you.
Dr. Melora Sundt, my committee member. Thank you for agreeing
to serve on my committee and for your feedback regarding this project.
Mr. & Mrs. C.H. Maxey, my parents. Thank you for all of the
sacrifices that you made to send me to college, for teaching me the value of
education and hard-work, and for the examples you have set for me in my
life. I could not have asked for better role models.
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Matthew Schumacher Gibbs, my wonderful husband, teacher, and
confidant. Thank you for always believing in me, for constant support, for
listening, for making the good days more joyful and the bad days less tragic.
Your understanding and belief in me is everlasting in my heart.
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TABLE OF CONTENTS
Acknowledgments ................................................................................... ii
List of Tables ....................................................... v
A bstract...........................................................................................................vi
CHAPTER 1. MENTORING IN NURSE ANESTHESIA
EDUCATIONAL PR O G R A M S....................................1
CHAPTER 2. REVIEW OF THE LITER A TU R E........................ 16
CHAPTER 3. RESEARCH METHODOLOGY ............................ 63
CHAPTER 4. FIN D IN G S.................................................................... 73
CHAPTER 5. D ISC U SSIO N .................................................................88
B ibliography............................................................................................... 117
A ppendices..................................................................................................127
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LIST OF TABLES
Table 1. Faculty Age .......................................................................74
Table 2. Years at Current Rank ................................................. 75
Table 3. Number of years as faculty .............................................75
Table 4. Highest Degree H eld........................................................ 76
Table 5. Faculty members leaving academic p o sitio n ............... 77
Table 6. Reason for leaving Institution........................................ 78
Table 7. Adequate m entorship...................................................... 79
Table 8. Important-Confidence-Desired Training.........................80
Table 9. Time actual to time id e a l................................................. 84
Table 10. Time actual to time idea..................................................... 85
Table 11. Short and long term goals ...................................... 86
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ABSTRACT
More than twenty percent (20%) of directors and faculty
members in graduate programs specializing in nurse anesthesia
education leave the field each year. This staggering figure has
remained constant over the past two decades according to the
American Association of Nurse Anesthetists (A AN A). (AANA,
2003) More than 95% of all nurse anesthetists are members of this
organization, yet we attract few to the academic arena and retain even
fewer over the long term. It has been established in the medical and
nursing faculty literature that mentoring new faculty may help in the
retention of all faculty members for a longer period.
The primary objective of this study was to investigate
academic mentoring within nurse anesthesia educational programs.
Faculty members may have very different expectations of their role
within the university setting as compared to their prior education and
employment. Faculty members at large may have different academic
expectations than commonly derived from their original clinically
based nurse anesthesia educational program. Lack of mentoring may
indeed be the root cause for the high attrition rate among faculty
members within nurse anesthesia graduate education. Lack of
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vii
mentoring has been identified as the root for attrition in many
different disciplines such as academic medicine, law, and business.
W hile the literature is well defined in these areas, it is poorly defined
in nursing and specifically nurse anesthesia education.
Expecting a clinically prepared nurse anesthetist to successfully
function in areas o f the academic arena, without adequate mentorship seems
to be the biggest challenge. University program administrators, experienced
faculty members, and new junior faculty members could benefit from future
research on the specific indicators for adequate mentorship programs.
Implementing a mentoring program specific to the needs of nurse anesthesia
faculty members is the key to decreasing the attrition rate and retention for
the future. W ithout adequate mentoring, more and more faculty members
specializing in fields with combined clinical and didactic education are
leaving for other opportunities. This was clearly evident by this research.
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CHAPTER 1
MENTORING IN NURSE ANESTHESIA
EDUCATIONAL PROGRAMS
Certified registered nurse anesthetists (CRNAs) have been providing quality
anesthesia care in the United States for more than a century. Nurses trained in
anesthesia were the first professional group to provide anesthesia services in the
United States and as such constitute the oldest recognized group of advanced
practice nursing specialists (Waugaman & Foster, 1995). The profession initially
evolved in response to the growing need of surgeons for trained anesthetists who
could administer anesthesia safely. Following M orton’s discovery of ether in the
1840's, anesthesia administration was typically relegated to medical students whose
primary goal was to study the discipline of surgery and anesthesia was one way to
appear in the operating room and become acquainted with surgery itself. However,
the anesthesia mortality rate became unacceptably high and surgeons sought a
practitioner who would provide exclusive attention and care to patients without
being distracted by other surgical activities.
By the 1880's, nurse anesthesiology had become a recognized area of
nursing expertise because nurses were particularly well suited to the task of expert
observation, clinical judgm ent and patient-oriented care during surgery. The
practice of anesthesiology by nurses has been recognized by the courts as the
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practice of nursing since 1917 (American Association of Nurse Anesthetists
(AANA), 1997).
Today, CRN As administer more than 65% of the 2.6 million anesthetics
delivered annually in the United States. (AANA, 2001) They work in every setting
in which anesthesia is provided including tertiary care centers, community
hospitals, labor and delivery rooms, ambulatory surgical centers, diagnostic suites,
and physician offices. CRN As are the sole anesthesia providers in more than 70%
of rural hospitals, affording anesthesia and resuscitative services in these medical
facilities for surgical, obstetrical, and trauma care. (AANA, 2001) More than
29,000 CRNAs practice in all 50 states and Puerto Rico, providing anesthesia
services to all segments of the population (AANA, 2001). Nationally,
approximately 40% of the practicing nurse anesthetists are men. (AANA, 2001)
Historically, the focus for everything related to the nurse anesthetist revolved
around providing safe anesthesia in the hospital. In fact, this is the best kept secret
profession in nursing.
Unfortunately, the strong emphasis on clinical practice has clouded the
actual importance of mentoring to those who teach graduate students preparing
future CRNAs. Currently there are 92 nurse anesthesia graduate programs within
the United States, some housed in schools of nursing and others are in schools of
allied health or other academic units. All programs provide a M aster’s degree upon
completion. Only one percent (1%) of the total CRNA population holds a doctoral
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degree according to the AANA Membership survey of 2003. Universities bound by
their own higher education accrediting agencies require a doctoral degree to teach at
the M aster’s level, however, when there is more financial incentive to continue in
the clinical arena, an academic position seems undesirable. W here will we get the
professors to teach these graduate students? Typically, CRNAs are recruited from
the hospital setting to enter into the academic world with little or no knowledge of
actual academic life except for their own experiences as a graduate student. The
clinical area offers “clinical precepting” usually in the form of an experienced
CRNA overseeing clinical case assignment or working hours, however mentoring
within the university system is very limited or nonexistent for medical and nursing
educational programs. (Chew, 1999) There is little mentoring attention to the
academic setting for nurse anesthesia educators where clearly there is a need. The
AANA report from 2003 indicated that there is a 20% attrition rate among nurse
anesthesia educators. M entoring or lack of mentoring could be the root cause for
this high attrition rate.
In early 2003, U.S. President George W. Bush gave a State of the Union
speech where he recognized the power of mentoring by saying “a mentor can
change a person’s life forever.” As a nation striving to compete in a global
economy, the value of human capital, is even more important. (Coleman, 1988)
Mentoring adults is a critical area in which to continue the investment of human
capital for the future. W ithout this investment in mentoring, medical school
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faculty, nursing faculty, and nurse anesthetist educators will struggle for survival in
their respective fields. Mass exodus from academic positions adds more injury to
the already decreasing number of faculty members in education of nurses and
physicians nationwide.
Critical linked to the nursing shortage— in a cause affect relationship— is the
shortage of educators. According to the American Association of Colleges of
Nursing, more than five thousand students were refused admission to undergraduate
nursing schools in 2003 because of a lack of faculty. (AACN, 2004) This has a
direct impact on those nurses who might seek graduate education within the
specialty of nurse anesthesia. W hile we might argue that all students benefit from
mentoring, nurse anesthesia programs in particular present educators with unique
needs for mentoring. Indeed it is fair to say that these programs are critically
dependent on mentoring for their success.
Background of the Problem
Prevosto (2001) noted that by mentoring, seasoned faculty can share experiences
with their inexperienced colleagues rather than forcing them to struggle alone.
Unfortunately, the experienced nurse anesthetist is sheltered within the confines of
clinical patient care and rarely realizes their full potential as an educator outside the
clinical setting for future nurse anesthesia students. Over the past twenty years,
three trends in particular— hospital downsizing, educational redesign, and corporate
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mergers within education and healthcare— have pushed many nurses away from the
profession and have also introduced clinicians into the world of academe. The
influx of clinicians to the professoriate stimulated much uneasiness for both
experienced educators as well as for new junior faculty. There is growing concern
that the known benefits of a nurturing relationship, are critically missing in the area
of adult mentoring among faculty and clinicians alike, especially in graduate
education. Keeping specialty graduate programs such as nurse anesthesia programs
alive will become a challenge for the new generation of junior faculty members.
In looking at the history of nursing itself over the past twenty years, we note
that gradual decreases in the number of registered nurses have been ongoing since
1983 and have had a significant impact on the number of applicants to graduate
schools of nurse anesthesia. It is these potential applicants who may become future
faculty members in the profession of nurse anesthesia. Faculty mentoring may
indeed help keep or attract new faculty members within the academic specialty.
However, without a tailored mentoring program, the attrition rate will continue and
programs may face significant changes including the possibility of closure due to
lack of qualified faculty members.
Statement of the Problem
Though the existing literature repeatedly proves the importance of
mentoring for career success, the implementation of successful mentoring programs
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in nursing education remains a challenge. A major roadblock in nursing consists of
finding mentors who understand the complex dynamics of mentoring, and will
persist in their obligations when problems develop. The attrition rate in the nursing
field as a whole also continues to deprive clinical and academic areas alike of future
mentors and faculty members.
The American Association of Nurse Anesthetists (AANA) has stated that
20% of the educators in nurse anesthesia programs leave their positions annually.
(AANA Annual M eeting Boston, 2003) This rate of attrition could indeed be the
death of a valuable profession to society. In a more recent study conducted by the
AANA of doctoral prepared Certified Registered Nurse Anesthetists (CRNAs),
found that eighty-three percent (83%) were over the age of 45 and fifty percent
(50%) were expected to retire in the next 10 years. The high retirement rate of
these CRNAs is explained by the national age distribution. The high retirement rate
predicted among doctoral prepared CRNAs is especially problematic for academic
institutions and will create a significant demand for doctoral prepared CRNAs in
the next ten years. Adding to the overall attrition rate among academic faculty
members is the flexibility of alternative employment settings such as ambulatory
surgery centers, physician offices, and pain management clinics offering shorter
working hours with less hospital involvement.
One outside entity, the American Association of Nurse Anesthetists
Foundation (AANAF) has recognized the value of mentoring since 1990. This
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professional foundation was established in 1981 to develop research for Certified
Registered Nurse Anesthetists. The AANAF has established weekend seminars
specific to invited Program Directors and faculty members within the specialty to
provide guidance on academic rigors. Topics include program accreditation and
administration, budgeting, establishment of new nurse anesthesia programs, and
research/publications. In addition, AANAF established a Mentor/Mentee Program
primarily focusing on those students within Doctoral Programs and linking them
with CRNAs who have already obtained their doctoral degree. This group meets
twice annually in conjunction with the AANA Annual meeting and Assembly of
School Faculty meeting held in February. The purpose of this pairing is to create a
dialogue and exchange of information between those with experience to those with
little experience in writing a doctoral dissertations and conducting research.
Supplemental seminars engage many faculty members and program directors and
provide encouragement for those new to nurse anesthesia education.
One short coming of these weekend programs from the Foundation is that
there is limited opportunity for regular follow up. The only mentoring opportunities
for these doctoral students are provided by the national educational meetings held
twice a year. However, this “spot check” is primarily geared toward conducting
research and has little to do with the academic arena. The lack of a follow up
procedure is a common failure among mentoring programs in other disciplines as
well such as medicine, law, and nursing. As the mentoring failure is particularly
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evident in nursing education, numerous schools and hospitals try to incorporate
mentoring components in undergraduate and graduate leadership courses, or
incorporate mentorship in faculty staff development (McWeeney, 2002).
Purpose of the Study
The specialty of nurse anesthesia education primarily involves those faculty
members who are board certified in the specialty and hold the title of Certified
Registered Nurse Anesthetist (CRNA). Nationally, there are approximately 30,000
practicing CRNAs; however, academically there are only 92 educational programs
that graduate approximately 1300 new CRNAs annually. It has been studied many
times over that these new graduates do not enter into the academic setting directly
from their graduate program, but rather move to the patient care area for both
gaining confidence in clinical practice as well as high paying salaries. These 92
educational programs have between 2-4 CRNA faculty members responsible for
academic aspects of the graduate program. Not included in this research are those
faculty members who classify their primary position (greater than 50%) as clinical
faculty within the patient care or hospital setting.
The purpose of this investigation was to examine the adequacy of
mentorship, and its impact on faculty members. This study examined current
mentoring practices to determine if they enable faculty members in continuing
career commitment. The research also investigated the attrition rate among faculty
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members, as well as the reasons for that attrition. When broken down further,
variables included patient care both in hospitals and ambulatory centers, teaching as
a group and one-to-one, research and publications, management skills including
budgeting and grant writing, and finally, scholarly work. This research also
examined the time allocations for the four major areas within the nurse anesthesia
academic setting: scholarly work, direct patient care, supervising/teaching, and
administration. The ideal, actual, and allocated percentages of time spent in each of
these areas helped to illuminate the necessary differences between them, when
expectations and demands are continually exerted on the faculty member. Despite
these demands, faculty understands the importance of mentoring, and it is possible
to establish a focused mentoring program. In establishing such a program, first and
foremost a self-assessment must be conducted to determine the need for specific
mentoring activities. W ithout a clear identification of these needs and activities,
mentoring becomes a stab in the dark that holds no real value for faculty members.
Research Questions
1. Do faculty members within nurse anesthesia educational programs have
mentoring as part of their academic life?
2. Is there a significant relationship among nurse anesthesia faculty
members’ long and short term goals and their intention to leave their academic
position?
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3. Is there a significant relationship between the importance and
confidence of academic faculty members in areas including scholarly work, direct
patient care, supervising/teaching and administration and the attrition rates in
nurse anesthesia educational programs?
4. Is there a significant relationship between the faculty m em ber’s actual,
ideal, and time allocated for the activities of scholarly work, direct patient care,
supervising/teaching, and administration?
Hypotheses
1. Graduate education in nurse anesthesia addresses patient care as the
only significant area within current educational programs. The expectations of
these clinical specialists are not in keeping with academic life and contribute to
the high attrition rate among educators in the field.
2. M entoring is vital for long term career commitment and is severely
lacking within nurse anesthesia educational programs. Identifying areas of
importance and desired training will help develop realistic mentoring programs
for the future of nurse anesthesia education.
3. Faculty members in nurse anesthesia programs are confident in areas
related to direct patient care, however, faculty members are not confident in areas
which are important to career commitment in education such as scholarly work
and adm inistration. Expectations are great, and disappointments are great enough
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to leave academic life.
4. Faculty members have strong differences between ideal and actual time
spent within scholarly work, direct patient care, supervising/teaching and
administrative aspects of their jobs.
Significance of the Problem
W hile mentoring programs are primarily geared to those of adolescent
years, more attention has been given to the mentoring of adults who seek a second
career, those moving to a new level of administration within an organization, as
well as those seeking education as a profession. This study was designed to
investigate the demographic, academic activities of faculty members within nurse
anesthesia educational programs and the mentoring activities employed. In
addition, the self-examination of short and long term goals of faculty members
was identified.
Nurse anesthesia educational programs focus on clinical competency in
the delivery of anesthesia to a variety of patients. Based on the clinical aspects,
educators rarely know the inner workings of the university academic world yet are
expected to leam “on the job”. Decreasing salaries for educators within the
specialty, the variety of clinical options for employment, and high attrition rates
among this group of faculty members has created great concern for the future.
Although there is no one method to guarantee an adequate supply of educators for
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nurse anesthesia programs for the future, early mentoring may be helpful in
recruitment, retention and career commitment over the long term. The
relationship between mentorship as a catalyst for building human capital and self-
efficacy in nurse anesthesia education have not been fully explored. This study
provides new information of interest to existing adult mentorship programs and
educators within the field of nurse anesthesia.
Assumptions
For this study, the following assumptions were made:
1. The data was accurately recorded and analyzed.
2. The subjects responded to the best of their ability.
3. The subjects were a representative sample of the academic faculty
members within Nurse Anesthesia Educational Programs.
Limitations
The following limitations to this study should be recognized:
1. Faculty members within NAEP do not represent all nurses, but a
subspecialty within nursing and even more of a subspecialty within
nurse anesthesia in the United States.
2. This investigation did not include those faculty members with 50%
or more of their employment dedicated to providing anesthesia care
within a hospital or other clinical setting.
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3. This study is limited to subjects who agreed to participate voluntarily.
Delimitations
The following delimitations to this study are present:
1. This study was not designed to measure changes or improvements in
faculty mentoring, but to examine areas which are indicated by the
study as indicators where improvements could be made.
2. This study measured only the faculty members within the academic
institution and not those clinical faculty members teaching students
within the hospital or other clinical setting.
3. This study confined itself to questioning faculty members within
accredited nurse anesthesia graduate programs only.
4. The primary focus of this study was on mentoring and on the
importance and confidence levels of faculty members in areas
including scholarly work, direct patient care, supervising/teaching
students and administration. In addition, each of these areas was
broken down into more specific skill areas.
5. O f those surveyed, only those appointed as a university faculty
member were included in the study.
6. Questionnaires were limited to program faculty members only
and not clinicians interfacing with students in the hospital setting.
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Definition of Terms
Anesthesiology: The study of the art and science of anesthesia
Aspiration: The strong desire to achieve something of greatness. It is
linked to personal, educational, and career goals (Bandura, et al., 2001).
Certified Registered Nurse Anesthetist (CRNA): A licensed registered
nurse who has graduated from an accredited M aster’s level Anesthesia
Educational Program and has successfully completed the national
certification examination.
Human Capital: The individual’s ability to produce and is enhanced
through education or training (Shultz, 1961).
Mentee: A lesser skilled individual paired with a more experienced
person, fostering personal growth through the process of shared
experiences (Nefstead & Nefstead, 1994).
Mentor: A more experienced person paired with a lesser skilled
individual, fostering personal growth through the process of shared
experiences (Nefstead & Nefstead, 1994).
NAEP: Nurse Anesthesia Educational Program. A fully accredited
graduate program specializing in Nurse Anesthesia education.
Precepting: One-to-one teaching through examples (Faut-Callahan, 2002).
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Mentoring: A planned pairing of a more experienced person with a lesser
skilled individual, fostering personal growth through the process of shared
experiences (Nefstead & Nefstead, 1994).
Self-efficacy: The belief that an individual’s judgm ents regarding their
own capabilities to organize and implement required plans of action
produce desired outcomes (Bandura, 1977).
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CHAPTER 2
LITERATURE REVIEW
Before conducting any research on mentoring, it is imperative to provide a
historical perspective through the available literature. This review encompasses
specialty educational programs such as nursing, medical schools and business.
Subsections of this chapter include a discussion of differences between mentoring
and precepting, leadership styles and some theoretical principles which have
guided mentoring activities for some. Finally, this chapter explores different
aspects of mentoring within business, the mentor-mentee relationship and the
specific difficulties of mentoring within the nurse anesthesia specialty.
In 2002, Ehrich et al. published a literature review of 159 pieces of
empirical literature on mentoring in educational settings. Findings confirmed that
mentoring offers numerous far-reaching benefits. These studies indicated that for
beginning teachers in particular, mentoring provided strong professional and
personal support as well as providing affirmation of teaching as a career. Greene
and Puetzer (2002) reported a lower attrition rate among new teachers who had
been mentored. In an editorial Tucker-Allen (2000) noted that students enrolled
in older rigid educational systems were usually not inspired to become educators.
In addition, Tucker-Allen observed that new teachers who have been mentored
are more likely to want to mentor others in the future. Thus the idea of adult
mentoring as an integral process of lifelong learning cannot be stressed enough.
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The business literature suggests that anyone who does not have a mentor is
handicapped. Zey (1984) found that individuals who did not have a mentor have
lower positions within an organization, and those with mentors rise to higher
status within similar organizations. Similarly, Bierema (1996) asserts mentoring
is a way to help new employees learn about organizational culture and to expand
opportunities for those traditionally hampered by organizational barriers for
women and minorities. Many mentoring programs have been geared specifically
to women and minorities as a way of helping them break through the “Glass
Ceiling” or the “Good Ole Boy Network” within the business world. This is
severely lacking with the academic setting.
A mentor can be very influential to those entering into a new profession.
The mentor serves as a sponsor, guide, and role model. Hunt and Michael (1983)
suggest that the relationship is similar to a partnership which progresses through
four phases: selection, protege, breaking up and lasting friendship. In the initial
phase, the mentor and mentee “choose” each other and define the nature of the
relationship.
Schim (1990) describes the Dalton/Thompson career development model
in which four discrete stages in the mentoring process are identified: dependence,
independence, supervising others, and finally managing and supervising others.
One strong theory of the mentor-mentee partnership was developed by Williams
and McLean in 1992. They use M aslow ’s hierarchy of needs to assist in this
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relationship development. They proposed using a nondidactic counseling
approach and an individual mentee assessment outline which identifies six
specific categories of personal learning needs: psychological, belonging, esteem,
cognitive, aesthetic and self-actualization. The mentor explores each level with
the mentee noting specifics for more individualized mentoring. For example,
safety needs may concern the m entee’s ability to recognize their own limitations
in the clinical setting, and belonging needs may affect being accepted as part of
the health care team.
In the area of health care, sometimes confusion may exist when using the
term mentor. The latter is often confused with orientation or precepting. These
concepts are also geared toward the clinical aspects of the relationship.
Orientation is generally defined as a passive role used to acquaint an individual
with an organization. Precepting refers to more one-on-one teaching through
examples. However, mentoring is quite different: It exudes qualities of wisdom,
teaching, reliability and caring within a strong personal and emotional
relationship. Mentoring relationships are an integral part of leadership and should
never be left to chance. They are planned and built on mutual respect and
consent.
Pointer and Sanchez (2000) define leadership as a process through which
an individual attempts to intentionally influence another individual or a group in
order to accomplish a goal. Leadership is a conscious process which includes
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defining goals and strategies, presenting those goals, implementing them, and
providing an overall evaluation of the process. Burns (1978) defines leaders as
either transactional or transformational. Transactional leaders are those who wish
to maintain the status quo. They offer little in the way of newness or creativity to
the protege. The transformational leader is one who seeks to upset and replace
the status quo. They offer an incitement to change and provide a sense of vision
for those they lead.
Studies of the impact of mentorship related to social and academic factors
have provided mixed outcomes. For example, studies with select populations of
“at-risk” minority males have resulted in insignificant differences related to self
esteem, attitudes toward drugs and alcohol, school absences, and disciplinary
actions. (Royce, 1998) Other longitudinal studies with students from the ages of
10 to 16 and 13 to 18, demonstrated increased attendance, academic performance,
application to college, and less frequent participation in high risk behaviors
(Johnson, 1998; Tierney, et al., 1995)
The relationship between how individuals think about their own potential
and how they imagine their future constitutes the way the configure the
possibilities that are open to them (Markus & Nuris, 1986). As Bandura et al.
(2001) have suggested, the will power to persevere in order to accomplish goals,
is greatly affected by one’s sense of perceived competence. Mentoring builds
confidence and builds those positive relationships for future successes. Specific
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to nurse anesthesia is the confidence in clinical care of patients within the
hospital.
Peluchette and Jeanquart (2000) studied the significance of mentors in the
growth and development and advancement of university faculty. They found that
not only was the presence of a mentor important, but also that having multiple
mentors was correlated with greater career success. They also noted that often
individuals have different mentors at different times during their career.
M entoring at different stages within a career change helped keep the mentee
engaged and assisted in the transformation into the new career.
Nursing overall as a profession is currently experiencing an undersupply
of personnel, a shortage which may be influenced by larger forces shaping the
field in recent years, including “widespread downsizing, redesign, mergers,
acquisitions, managed care and other evolutionary forces” (Crosby & Dunne,
2003, p. 424). Advances in medicine and technology, with concomitant changes
in treatment modes, are also said to impact the field of nursing (McWeeney,
2002). One major change in nursing has occurred in the process by which
prospective nurses are educated: nursing education has been increasingly
integrated with universities (Landers, 2000). This has impacted the nature of
nursing education, but also brought the issues and the problems of each
field— academia and nursing— into each other’s domain. Attrition of junior
faculty from the academic to the practice side of nursing has raised a cry for
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21
innovative policies to stem the tide. Mentoring has been suggested, along with
other solutions, as the primary way in which junior faculty can retain the love of
teaching that originally caused them to choose teaching over practice, and resist
the economics-based pressure on them to expand clinical time while reducing
teaching or research time, until they opt out for practice in the end (Papp & Aron,
1998).
The concept of mentoring originated in Homer’s Odyssey, when Mentor, a
trusted friend of Odysseus, undertook the education of Telemachus while his
father was away (Andrews & Wallis, 1999; Savett, 2002). The image projected
from the source, then, depicts a mentor as “an older, wiser male who takes on the
responsibility for a younger m ale’s learning and development, rather like that of a
guardian” (Andrews & Wallis, p. 202). Professions such as medicine, law and
business have had a mentoring ethos in the past, but it was only in the 1970s that
the idea of mentoring appeared in the nursing literature (Andrews & Wallis,
1999). The term mentor arrived in the United Kingdom soon after and “slipped
into the folklore of nurse education almost unnoticed” over the next two decades
(Gray & Smith, 2000, p. 1542). A doctoral thesis by McW eeney constituted the
first study of mentoring in a nursing context (McWeeney, 2002). In 1987, the
English national board for Nursing, Midwifery and Health Visiting mandated that
qualified staff must set aside some of their time for mentoring (Jones & Walters,
et. al., 2001).
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W hat exactly a mentor is, and what he or she does remain a problem of
definition in the nursing literature in particular (Dingman, 2002; Gray & Smith,
2000; Jones & W alters, et. al., 2001; McWeeney, 2002; Watson, 1999). Several
studies have conducted literature reviews in nursing in order to determine the
extent and nature of mentorship in the profession. In a search in the early 1980s,
little evidence of quality research on these questions in nursing was evident (Gray
& Smith, 2000). In much of the literature since, particularly in the United
Kingdom (where mentorship was adopted from American models in the 1980s),
the term mentor and preceptor are used nearly interchangeably (Gray & Smith,
2000), a situation which has caused problems in providing quality mentoring.
Generally, mentors are defined as experienced individuals in a profession who
offer guidance and support to newcomers in order to help them navigate the
complexities of professional life (McWeeney, 2002). “Good mentors guide,
direct, support open doors and provide that sense of belief in neophytes that they
can do it, that someone is there to back them up” (McWeeney, p. 4). In order for
such a relationship to succeed, both mentor and mentee need “appropriate
preparation” (Watson, 1999, p. 256). Because there remains some question
concerning the definition of mentoring in nursing, researchers have gone outside
of nursing in order to find a more accurate definition.
Outside nursing, a mentor is “someone who helps an individual through
important decisions in learning, adapting to a new situation or environment,
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2 3
personal and career growth” (Watson, 1999, p. 254). Outside of nursing, mentors
are mostly older individuals, usually men, who provide support for “younger
inexperienced individuals within an organization, helping them in their career
development” (Watson, p. 255). The fact that, for some, mentoring represented
the “old boy” network within established businesses may have been the triggering
factor “for its introduction into the nursing context in the United States” (Watson,
p. 255). Good mentors provide beneficial advice, trust their proteges, and do not
judge when mistakes are made. They “build and promote a culture of self-
direction and team-building” in an organization, and “nurture the ability for others
to realize and develop their full potential by confronting and overcoming self
doubt and fear” (Dingman, 2002, p. 10). Mentors also share their passion about
their work, facilitate learning “without providing solutions” (Dingman, p. 10), and
provide “an opportunity to apply theory to replicate the thinking that goes into
practice” (Dingman, p. 10). These outside models of mentors have been used to
clarify mentoring in nursing.
In issues of nursing especially, a mentor can exist on the practice or the
educational side of the field. In practice, a “mentor is a staff nurse who has the
responsibility for facilitating the application of theory to practice” (Gray & Smith,
2000, p. 1545). A mentor should act as a role model, “facilitate the m entee’s
clinical learning experiences on the placement, undertake clinical teaching, and
supervise and assess the student’s practice on that placement” (Jones & Walters,
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2 4
et. al., 2001, p. 151). The nursing profession now routinely uses mentors to
facilitate both learning in the field, and junior faculty in nursing schools as well
(Suen & Chow, 2001).
One problem cited in nursing mentoring is that the terms mentoring and
preceptorship have been used synonymously, when they are indeed different.
Attempts have been made to distinguish between a preceptor role and a mentoring
role in the nursing context. Some researchers review mentoring, preceptorship,
coaching and role modeling, and find different emphases in different roles
(Dingman, 2002). On the basis of comparing these variations of clinical
advisement or supervision, true mentoring relationships are separated from what
are called “pseudo-mentoring relationships” (Watson, 1999, p. 255). The
preceptor is a fairly recent introduction into nursing, and refers to a person who
facilitates newly qualified nurses moving into a new or unfamiliar area of clinical
practice (W atson, 1999). A preceptor “guides the development of another person
in a particular work setting for a specified period of tim e” (Dingman, 2002, p. 9).
The relationship is agreed upon and seen by others, and based on specific policies,
procedures and standards for a short period of time (Dingman, 2002). By contrast,
a coach encourages “supports, guides and aids another to raise competency in the
areas of performance, critical thinking and interpersonal domains” (Dingman, p.
10). Coaches focused on a desired result and “create a learning connection with
the staff m em ber built on mutual trust” (Dingman, p. 10) for as long as the
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prescribed task needs. Coaching is supported by “specific learning objectives” and
entail “day-to-day feedback and development activities aimed at enhancing
performance plans the pair develop jointly” (Dingman, p. 10). A role model is
another form that guidance can take, and it consists of a “person who serves as an
example to someone else with or without a relationship with that individual”
(Dingman, p. 9). Many argue that any or all in the above package of activities
constitutes mentoring, while others argue that such short-term task-specific
relationships only constitute ‘‘ pseudo-mentoring’’ in that they are indeed focused
on specific defined outcomes and “the student has little or not say in the choice of
the mentor” (Jones & Walter, et. al., 2001, p. 151). W hether or not faculty
mentoring in nursing partakes of the fullness of the mentoring potential is also an
urgent question (see below).
In order to create a still more supportive environment for mentees on the
nursing faculty, many researchers have investigated further into mentoring in
order to determine what distinguishes it from preceptorship, coaching, or acting as
a role model (Andrews & Wallis, 1999; McWeeney, 2002; Suen & Chow, 2001;
W atson, 1999). The answer in all cases is the nature and length of the relationship
between mentor and mentee. The depth of the relationship between the mentor-
mentee team, and the length of the relationship (which can extend across an entire
academic career) are what sets true mentoring apart from many of its shorter-term
implementations in nursing. Mentoring is a much larger and broader concept than
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2 6
mere coaching, or preceptorship guidance in achieving a specific result.
M entoring also entails advice on issues including career socialization, inspiration
and belief, and promoting excellence and passion through support and guidance
throughout a career (McWeeney, 2002). Such long-term guidance may lead a
senior mentor to become a friend, or buddy of a junior educator, even if
mentoring remains strictly professional (Watson, 1999). Whereas a coach or
preceptor will withdraw support from the junior mentee as the task nears
completion, using a form of educational scaffolding, a mentor will put the
relationship as a whole on another level, opening doors and providing long-term
career advice beyond the clinical area. According to the literature then, it is the
quality of the mentoring relationship that separates mentoring from other forms of
practice guidance (Andrews & W allis, 1999). Only when the mentor rises above
the immediate tasks at hand to offer guidance that will lead a person along in an
academic career in an effective manner, does guidance transform into true
mentoring (Suen & Chow, 2001).
Further research verifies the long-term mandate for mentoring, by finding
that mentoring has played an important role in every career stage of mentees
(McWeeney, 2002). Each stage of a career requires a different kind of mentoring
as well.
It has been asserted that only by moving beyond the dyadic nature of the
mentor-mentee relationship can mentees truly be helped to navigate the chaos of
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contemporary employment, especially in the nursing field, but also in academic
fields in medicine as a whole (Vance, 2002). Some observers believe that rather
than expecting that order and understanding will come at some future stage of
expertise, organizations ought to accept chaos as their premise and embed in their
structures ongoing mentoring relationships that will assist all employees to move
through the system (Vance, 2002). M entoring may not be enough, and perhaps
only a “mentoring mentality” may result in organizational progress. This
mentality would entail collaboration instead of competition; respect, learning and
support rather than contentious challenging; and eventually help an organization
evolve into a “learning-mentoring organization described by organizational
theorists” (Vance, 2002, p. 7).
As nursing absorbs these ideas, it is observed that mentoring is “not just
frosting on the cake anymore” but “an essential ingredient of professional
practice” which must be practiced in formal and informal ways by all
(McWeeney, 2002, p. 4). Because of this increased emphasis on the personal
relationship, the literature is also concerned with what makes both a good and
bad mentor in the nursing education environment. The personal characteristics of
the mentor have become the object of increased focus (Andrews & W allis, 1999).
If a mentor is not approachable, is ineffective in interpersonal skills, if he or she
has not adopted a positive teaching role, paying appropriate attention to learning,
and providing supervisory and professional development support as well, he or
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2 8
she cannot be called a good mentor (Andrews & Wallis, 1999).
Only a good mentor can inspire, invent and support development for a
mentee (Andrews & Wallis, 1999). Others go so far as to itemize fourteen
elements of a good mentor: (s)he is a “model envisioner, energizer, investor,
supporter, standard-prodder, teacher-coach, feedback-giver, eye-opener, door-
opener, idea-bouncer, problem solver, career counselor and challenger” (Andrews
& Wallis, 1999, p. 204). Moreover, a mentee must also be “good” by being
passionate and engaged with nursing as well.
Only if both mentor and mentee are “good” can there develop what the
literature defines as a true mentoring relationship. This would entail mutual
attraction, mutual respect and a sufficient “subscription of time and energy”
(Andews & W allis, 1999, p. 204). Indeed, mentoring is described as an “intense
relationship calling for a high degree of involvement” between mentor and
mentee (Andrews & Wallis, p. 203). Nursing education in particular has moved
from exclusive, dyadic models of mentoring to more “inclusive, diverse and
enduring models” (McWeeney, 2002, p. 3).
The general literature on mentoring in the field of nursing describes case
studies in which mentoring results in improved nursing outcomes. In one study,
the assignment of mentors to Native and Inuit nurses in Canada was found to
increase their success on the job (Petten, 2001). Another study evaluated the
effectiveness of mentoring for registered general nurses, and found that, even
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2 9
though one-third of nurses felt that mentoring failed them, “having a mentor was
beneficial for the majority” of the nurses (Andrews & Wallis, 1999, p. 204). In
another study, nurses who had received just an orientation workshop as opposed
to clinical mentoring reported feeling short-changed by the program (Andrews &
Wallis, 1999).
Though the literature appears to have proven the importance of mentoring
for clinical career success, the implementation of mentoring in nursing and its
education remains a challenge. A major roadblock in nursing mentoring is finding
people who will mentor, who understand what mentoring is, and who will not quit
mentoring as soon as problems develop. The attrition rate in the nursing field as a
whole also continues to deprive clinical and academic areas alike of future
mentors. Traditionally, mentors were full time employees of hospitals, and “held
regular nursing duties in the units they were committed to” (Suen & Chow, 2001,
p. 505). This can also be said for those mentors within nurse anesthesia
educational programs. The majority of faculty members continue to hold a
clinical responsibility to provide patient care in conjunction with academic
mandates of the university.
The way mentoring in nursing has evolved has surprised some researchers,
who, while intending that mentors should “take responsibility for the overall
educational quality of the clinical department” did not think that mentors would
be working in the field (Jones & W alters, et. al., 2001, p. 157). Only when
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mentors begin to see mentees as partners “at appropriate stages in their education”
(Andrews & W allis, 1999, p. 205) will such practical contact work. Moreover,
many mentors find their multiple roles in the clinical side of education stressful,
and feel that the complexity of their responsibilities is under-appreciated by
management (Watson, 1999). Mentors also sometimes feel inadequate, either
because they were themselves poorly trained, or because they have not been
properly prepared as mentors. Many mentors have not undertaken diploma level
education in mentoring, and many more have doubts about their level of
preparation. Mentors also generally appear undereducated on the importance of
socializing students in the workplace, and many often work with poor definitions
themselves of their roles (Cope & Cuthbertson, et. al., 2000). As this failure is
particularly evident in nursing mentoring, numerous schools and hospitals
continue to incorporate mentoring components in undergraduate and graduate
leadership courses, or incorporate mentorship in faculty staff development
(McWeeney, 2002).
W hile finding good mentors therefore appears to be a problem with
nursing, many researchers look to mentoring for a solution to the turnover and
attrition rates in various thresholds in the nursing field, as well as a general
nursing shortage (Dingman, 2002). Good nurses continue to leave organizations
too early, “when within a few months of being part of an appropriate mentoring
connection, the outcome may have been different” (Dingman, 2002, p. 9).
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31
W ithout mentoring, young nurses struggle to obtain the level of job satisfaction
that guarantees their long-term commitment to the field (Dingman, 2002). Many
junior nurse faculty members are also leaving the academic for the clinical side of
the field, an attrition thought to be stoppable by mentoring (Papp & Aron, 1998).
M entoring has been shown in several studies to have improved the nurse retention
rates at hospitals (McWeeney, 2002) and is said to have a similar impact at
academic medical centers (Cawyer & Simonds, et. al., 2002, p. 234).
As the research of M cW eeney (2002) has shown, mentoring has
significantly improved graduation rates in schools of nursing. Implementing more
mentoring is seen as “particularly crucial now” as a means to deal effectively with
the recruitment and retention problems in the field, both in practice and in
education (McWeeney, 2002). “This is a time of crisis for nursing” (McWeeney,
2002, p. 6), and mentoring may be one way in which universities and hospitals
may alleviate the retention problem. W hile the literature generally demonstrates
the effectiveness of mentoring in improving the outcomes of nurses, and reducing
recruitment and retention problems both for nurses and nurse educators, “there is
still not enough research on mentoring” in the field (McWeeney, 2002, p. 6). Too
much mentoring continues to be conducted “in corporate venues and the older
professions” and in research the experience of mentoring is generating primarily
anecdotal opinion pieces as to its pros and cons. Continued definitional and
methodological issues continue to plague nurse mentoring, and more long-term
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3 2
research is needed in order to determine best practices (McWeeney, p. 6). While
this problem remains generalized in the field of nursing in sum, all of the
mentoring issues become more urgently highlighted in the specialties of what is
termed advanced nursing, where nurses move on and up to engage in particular
subspecialties of service within the field.
Nurse Anesthesia and its Difficulties in M entoring
Certified Registered Nurse Anesthetists (CRNAs) em erged one hundred
years ago, and that “specialty practice of nurse anesthesia has evolved over time
into one of the most challenging areas of advanced nursing practice” (Heikkila,
2002, p. 15). Because nurse anesthetists administer up to 65% of all anesthetics
given to patients in hospitals, the field has developed a sense of practice “with a
high degree of autonomy” (Fort W orth Star Telegram, 2003, p. 1). As a result,
over the past generation, nurse anesthesia has increasingly sought to define itself
as a separate field, not simply a subspecialty of nursing. In the late 1970s, a new
requirement developed that nurse anesthetists should “complete an academic
program, which included an undergraduate degree in nursing and a graduate
degree in nurse anesthesia” (Fort W orth Star Telegram, 2003, p. 1). Demand for
nurse anesthetists peaked in the mid-1980s, after which point the number of nurse
anesthetist programs offered began to decrease. From 1975 to 1991 there was a
decrease from 210 nurse anesthesia educational programs to 91, and a decrease of
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33
graduates in nurse anesthesia from 1200 to 669 over the same period (Myers &
Martin-Sheridan, 2002). Changes in “healthcare reimbursement at the federal
level” increasingly became a risk factor “affecting the decision to close nurse
anesthesia programs nationwide” (Myers & Martin-Sheridan, p. 359). During the
1987-1999 period, 32 nurse anesthesia programs closed (with 128 total lost since
1974). Once again, new “financial issues related to cost containment strategies on
the part of healthcare” have become a primary reason for the closure of such
programs (Myers & Martin-Sheridan, p. 362). Even though there continued to be
about 900 graduates a year through the late 1990s, new factors contributed to the
emergence of a shortage in nurse anesthesia providers (M astropieto & Horton,
2001). “By early 2000 the CRNA shortage was quite evident and nurse anesthesia
programs were (continuing to be) threatened by a managed care program that no
longer wanted to fund education” (Mastropieto & Horton, p. 457).
A review of nurse anesthesia as a specialty reveals a matrix of problems
which may indicate why attrition rates in both nurse anesthesia and its educational
process continue to be too high (Eckhout & Robert, 2001; Heikkila, 2002; Myers
& Martin-Sheridan, 2003; Papp & Aron, 1998). In addition to a nationwide
shortage o f nurse anesthetists, the specialty of nurse anesthesia has unique
education and practice challenges (Heikkila, 2002). M any students are unable to
attend a full-time program based on their own financial problems. Admission
criterion for entry into a nurse anesthesia educational program is highly
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3 4
competitive. Finally, the healthcare system’s and hospital’s concern for the bottom
line has also impacted nurse anesthesia in practice and in education (Rowland &
W offord, 1999; Gray, 1998). Hospitals need clinical practitioners as soon as
possible to provide service to patients. Hospitals are not in the education
business, but rather leave that to the universities. The dual dilemma of clinical
importance and retaining educators for those students is a vicious cycle.
The literature broadly confirms the emergence in recent years of a
significant shortage in nurse anesthetists at hospitals. Rowland & W offord (2003)
remark that hospitals “that continue to enjoy stability within their anesthesia
departments should not plan on their good fortune lasting indefinitely” (p. 68).
Attempting to recruit a good anesthetist, whether physician or nurse, places no
emphasis on mentoring but focuses only on the immediate problem of lack of
clinical providers (Eckout & Shubert, 2001). There cannot be more clinical
providers if nurse anesthesia educators leave the field.
In the clinical arena, more and more hospitals are “scrambling” to
schedule both nurse anesthetists and anesthesiologists for daily work, or to be on-
call in case o f an emergency (Salina Journal, 2003). One hospital was reported to
be on the verge of closing its operating room “because they don’t have enough
nurse anesthetists” (Fort W orth Star Telegram, 2003, p. 1). W hile department
chairs struggled with recruitment, starting salaries in the field have risen (Eckout
& Schubert, 2001), but this situation has not yet reversed a long-term trend in
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35
undersupply of anesthetists.
The shortage problem that developed through the 1990s was exacerbated
by two circumstantial factors. In 1994 a report on future employment needs in
anesthesiology made several inaccurate assumptions about future employment
demands. The report projected graduate needs without considering the growth in
volume and range of surgical procedures, the impact of an aging population and
new surgical advances, and the “unabated use of physician extenders” (Eckout &
Schubert, 2001, p. 1). The report, based on its faulty premises, predicted an
“oversupply of anesthesiologists for the foreseeable future” (Eckout & Schubert,
p. 1), inhibiting some from entering the field at that point.
A second factor which contributed to dampening the entry of potential
nurse anesthetists into the field was the discussion concerning large-scale
healthcare reform in the Clinton administration. This, coupled with a report from
the Accreditation Council for Graduate Medical Education (ACGME) in 1994,
which recommended limiting the total number of residents to 110% of the
previous year’s graduates, and limiting specialists to 50% of all positions, caused
medical school deans to discourage medical students from pursuing specialties
such as anesthesiology (Eckout & Schubert, 2001). The declining educational
programs in both nurse anesthesia and medical residencies of the 1990s have left
an enormous hole in the clinical side of the supply-demand equation of anesthesia
providers for this new century. Clinicians in anesthesiology are in a high demand
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36
state today. The percentage of medical students interested in an anesthesiology
residency declined from 87% in 1994 to 43% in 2000; from 1994 to 1996 alone,
the number of graduates decreased from 1,873 to 745 (Eckout & Schubert, 2001).
The number of anesthesiology resident graduates decreased as well, from 1547 in
1996 to only 392 in 2000) (Rowland & W offord, 2003). The decline in the
number of graduates from residency programs has not recovered, and as Rowland
and W offord note again, “has grown little in recent years” (p. 67).
The overall number of CRN As in the United States dropped 2% from
30,386 in 1996 to 29,844 in 2000. But this number is “likely to decrease further in
coming years” (Rowland & W offord, 2003, p. 67). The growth rate of the field
has slowed to a “snail’s pace” (Eckout & Schubert, 2001, p. 1), with a growth rate
of 3.5 in the 1990, slowing to 0.6 after 1998. “This sluggish growth rate is echoed
in the membership growth of the American Society of Anesthesiologists (ASA),
with only 256 new active members added in 1999” (Eckout & Schubert, p. 1). At
present, it is estimated that there is a shortfall of approximately 1500-4000
anesthesiologists nationwide, and if current surgical demand continues, this
shortfall could reach as many as 7,900 anesthesiologists by 2005 (Eckout &
Schubert, 2001).
There are several additional reasons for the exacerbation of the shortage in
recent years (following from the initial healthcare-financing related issues in the
1990s). For one thing, a “disproportionately large number of nurses” (Rowland &
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3 7
W offord, 2003, p. 67) have begun to retire, a trend that will continue throughout
the decade. Secondly, the supply of anesthesiologists and nurse anesthetists “has
not kept pace with the demand for their services” (Rowland & Wofford, 2003, p.
66), as surgical volumes have increased, outpatient surgical volume has increased
even more rapidly, and “the explosive growth in the number of outpatient surgery
centers” has made a bad problem worse (Rowland & W offord, p. 68). In addition,
there is a new clinical area called “office practice” which also draws experienced
nurse anesthetists and anesthesiologists away from the conventional hospitals and
outpatient surgery centers. Shorter days, less stress, and fewer complications
occur with the office setting population. Generally, these patients are healthy and
the nurse anesthetist or anesthesiologist is not confronted with high risk of poor
outcomes.
The aging of the population has contributed to the growth in surgical
volume. The number of people over 65 increased by 11% in the past decade,
while the number of people over age 85 increased by 34%. W ith the inpatient
procedure rate for this population being three times more than the general
population, this demand for surgery creates serious problems (Eckout & Schubert,
2001). As available nurse anesthetists try to cope with volumes which have grown
“out of proportion” to their capabilities, and many, indeed, now split their time
between in- and outpatient services, many suspect that their overall productivity is
dropping as well (Rowland & W offord, 2003, p. 68). To meet the demand,
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38
hospitals continue to hire more anesthesiologists and nurse anesthetists, with
starting salaries now passing $100,000 (Fort W orth Telegram, 2003), but almost
47% of hospitals in one questionnaire still reported that “they do not have an
adequate number of anesthesiologists on staff’ (Kohn & Hasty, 2002, p. 3).
The impact of this shortage on medical care is clear. In one report,
seventy-five percent of hospitals have seen an increase in the wait time for
elective surgery due to a lack of anesthesiologists (Kohn & Hasty, 2002).
Moreover, almost two-thirds of all hospitals have begun to “limit access to
operating rooms due to the lack of anesthesia providers” (Kohn & Hasty, p. 3). In
another questionnaire, the nationwide shortage was shown to be “beginning to
have a profound effect in larger hospitals, delaying elective procedures, and in
extreme cases closing down surgical suites” (Kohn & Hasty, p. 3). Adding to this
problem is the fact that Medicare, the largest insurance HMO for our aging
population, has continued to cut payments for anesthesia services, preventing “a
number of practices from being able to hire sufficient numbers of anesthesia
providers” (Kohn & Hasty, p. 3). The high demand for clinical nurse anesthetists
has also impacted academic nurse anesthetists with enticing financial sign on
bonuses in excess of $20,000 for a year or two commitments. Universities cannot
keep pace with these salaries and bonuses compounding the high attrition rate
among academic faculty.
W hile the overall shortage of clinical nurse anesthetists therefore appears
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to be related to broad financial and healthcare industry issues, the particular
difficulty of the specialty itself may contribute to the sharpness o f the shortage in
the immediate future (Heikkila, 2002). The shortage has slowly dismantled the
educational infrastructure of nurse anesthesia programs, a calamity that can only
exacerbate the shortage. More educational programs for nurse anesthesia have
continued to close due to faculty shortages and further attempts by managed care
to control costs. A secondary problem developed in recent years as financial
distress caused many hospitals to switch from not-for-profit to for-profit status.
W ith a focus on the bottom line, many programs that were affiliated too closely
with hospitals were cut because they were “perceived to be inhibiting the
generation of revenue” or simply because the educational endeavor includes
clinical demands in operating rooms slowed procedures in ways that cost hospitals
money (Myers & Martin-Sheridan, 2002, p. 363). It is conceivable that the shaky
ground upon which the educational branch of the anesthesiology continuum
stands may further incite educators to switch from education to practice itself, in
order to secure some job stability.
Adding to the problem is that nurse anesthesia itself is a difficult specialty
to learn and practice, and as a field, with demarcated guidelines and procedures,
nurse anesthesia both before and after operations is an area that “has been under
represented in nursing research” (Prowse & Lyne, 2000, p. 1115). CRN As must
“master a number of complex motor skills and develop efficient and accurate
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40
problem-solving skills for an ever-changing environment” (Wren, 2001, p. 273).
Being a CRNA involves “not only mastery of scientific content but also
application of scientific principle into clinical practice” (Wren, p. 376). Moreover,
there is a peculiar emphasis on the finesse of practice in nurse anesthesia that
comes only with experience. M ore than most other specialties, anesthesiology is a
practice that cannot be mapped out in advance, it must be experienced. Nurse
anesthetists talk of the “importance of touch during the insertion of (for example)
an epidural catheter” where one “really has to develop their own feel for it”
(Wren, p. 276). In this field, then, the cues for how to perform are “more intuitive,
operating at a subconscious level, and are not so readily amendable to definition
and identification” (Wren, p. 276). This described character of the practice not
only places more emphasis on clinical practice education than in other fields, it
makes life much more difficult and pressured for educating mentors in the field.
The specter of fatality clearly continues to haunt the anesthesiology field.
In the clinical area, death rates from errors during the peri-operative
administration of anesthesia have dropped considerably over the past generation.
This lower rate can be attributed to new drugs, technologies for monitoring
patients, and even new educational demands.
In 1980 one out of every 10,000 patients died through some anesthesia
error, while today the number is closer to one out of every 200,000, a significant
reduction of danger in peri-operative care (Kremer & Faut-Callahan, et. al., 2002).
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41
Even though the current rate of error is low, “questions about surgical patients’
safety related to the type of anesthesia providers” remain (Pine & Holt, et. al.,
2003, p. 109). W hile a study in the 1980s found that anesthesiologists or nurse
anesthetists were responsible for more deaths (and a suspicion of lack of expertise
appears to continue to haunt nurse anesthetists), a recent study from North
Carolina indicates no significant difference between the anesthesiologist and nurse
anesthetist (Pine & Holt, et .al. 2003). Indeed, clinical outcomes today are more
often attributed not to the type of provider of anesthesia, but to “the greater but
unmeasured complexity of anesthesia cases” (Pine & Holt, et. al, p. 113). This
global study from Pine & Holt of clinical case competency may also be attributed
to the higher educational level achieved within nurse anesthesia programs as well
as higher clinical demands placed within the current curriculum. Unfortunately,
the increase in clinical focus to promote this lower mortality rate does not truly
affect the high attrition rates among nurse anesthesia faculty. Or do the demands
of clinical practice contribute to the high attrition rate among nurse anesthesia
faculty?
It is no surprise, from a cursory review of the practice of nurse anesthesia,
that a study of nurse anesthesia graduate students reported that “the nurse
anesthesia care situation was experienced and viewed to be difficult and
demanding” (Mauleon & Ekman, 2002, p. 286). Practitioners also felt that the
stress levels were higher in anesthesia than out in the hospital ward in general.
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Earlier on, it was this clinical stress which stimulated some nurse anesthetists to
seek educational positions within the university setting, leaving the lucrative
clinical practices behind. However, the current literature does not suggest that
stress continues to be a factor in motivating the shift to education..
Educational difficulties also emerge from reports of the experience of the
practice of nurse anesthesia. The length and complexity of operations is expected
to rise in coming years, particularly when related to the growing elderly
population (Ouelette & Bruton-Maree, 2002). The changing and expanding
venues of surgery, from diagnostic radiology, to dentistry, to office-based practice,
will also greatly complicate anesthesiology (Oulette & Bruton-Maree, 2002). This
flexibility in site will only be further expanded by other advances in technology
and pharmacology (Hornsby, 2002). New procedures that take a fraction of the
time they formerly did will not only reduce the risk of blood loss or need for
anesthesia, but also helps patients avoid costly overnight stays at hospitals
(Hornsby, 2002). It is predicted, in fact, that by the middle of the decade 80% of
surgeries will be outpatient, with many performed in office-based contexts
(Hornsby, 2002). This will undoubtedly force anesthetists to rethink and
streamline their procedures, in effect, reinventing their discipline in response to
every technological, pharmacological and infrastructural change. At the same
time one researcher suggests that many physicians will recapture anesthesia
practice in order to control their office costs (Eckout & Schubert, 2001).
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4 3
The complexity of the practice of anesthesiology may account for the fact
that only 18% of currently practicing nurse anesthetists have been working for
more than 3 years, while 62% of nurse anesthetists have been at work for more
than 10 years (Stromberg & Sjostrom, 2003). The increasing difficulty of the
gauntlet of degrees and education that a nurse anesthetist needs may weed out all
but the truly committed by the time they come to practice (Crosby & Dunn, 2003).
For this reason, more universities are seeking studies that outline the personal
characteristics that would be required for a CRNA (Crosby & Dunn, 2003). The
resulting profile ranges from ethical to technical skills, defining the nurse
anesthetist clearly as an ethical, highly-skilled professional (Crosby & Dunn,
2003). It has been noted in the literature that nursing, but particularly nurse
anesthesia, suffers from high attrition rates in many different areas. As nurses
leave the profession, as specialized nurses leave for subspecialties, as students
leave clinical programs and as young faculty leave to enter practice, attrition is a
watchword of the nursing field (Waugaman & Aron, 2003). The attrition in
students appears to occur mostly at precisely the point when students leave the
classrooms and enter the clinical side of their education. “This time period is a
particularly stressful period for students, causing at-risk students to leave the
program” (W augaman & Aron, p. 13). A weeding-out process appears to remove
from the field those individuals who are in it for the money (more common when
demand outstrips supply) and not the craft: early students report being interested
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44
in the economic reward of anesthesiology, while students closer to graduating talk
only about the field itself (Waugaman & Aron, 2003). That said, the jolt of
clinical experience may weed out older students as well, who are less willing to
transcend the hardships faced by nurse anesthesia students in the first clinical
months (W augaman & Aron, 2003). Moreover, if socialization does not occur in
the clinic, student values will not change to the point that they accept the
difficulties of the field (Waugaman & Aron, 2003).
Compounded by the high stress of bridging the theory into clinical
application, if a good clinical mentor does not establish a solid relationship with a
nurse anesthesia student, that student’s performance is often affected adversely
(Savett, 2002). The same holds true in education at the university level. If
academic mentors are not available, focused, and included into a new faculty
member’s academic environment, difficulties within the field will also continue.
In addition, if the expectations of the new faculty do not match the overall job
demands, attrition continues. W hile the basis for nurse anesthesia education is
primarily clinically driven, post graduate continuing education can involve
mentoring programs within the academic setting.
An added problem is that while there are few enough nurse anesthetists,
only a very small minority of them remains committed to mentoring other nurse
anesthetists, as faculty mentors in practice clinical settings. Another reason for
the shortage in nurse anesthetists appears to be the continuing migration of
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educators from academic contexts into full-time practice— further exacerbating
the shortage problem by foreclosing on the education and clinical training of
future nurse anesthetists.
There is a significant difference between the literature on nursing and
mentoring in general, and nurse anesthesia and mentoring. The nurse anesthesia
specialty clearly lags behind nursing as a whole for mentoring in both clinical
areas and academic faculty mentoring positions. No longer do we look to the
medical models of education and mentoring. Medical education itself is facing
difficulty with retention of qualified faculty. Mentoring in those educational
programs which contain a high clinical component to the curriculum such as
medicine and nursing continues to focus on the practice side and less on the
academic side. Future educators are at a high risk of failure and burnout early on
without attention to university mentoring at large. W ithout educators, the
numbers of students decrease, the number of graduates decreases, and the demand
for competent clinical practitioners escalates even higher. Providing mentoring to
educators in the specialty of nurse anesthesia education will hopefully enable
higher retention and therefore decrease the need to move from academic positions
to solely clinical positions.
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46
Medical School Faculty Attrition
There is some evidence that medical and nursing schools are developing
models to adapt to the new pressures on faculty life (Papp & Aron, 2000). New
systems which give credit to teaching activities for use in tenure review, and allow
for consideration as well inventories of time spent preparing for and in contact
with students is also a good step (Papp & Aron, 2000). Education is also
increasingly being recognized as a product line in addition to research and patient
care, and is also being “identified as a source of revenue” (Papp & Aron, 2000).
By quantifying teaching, not only is faculty reimbursement more accurate, but
teaching is being respected in a way that will reduce attrition by young faculty
who are interested in teaching (Papp & Aron, 2000).
By far the most common program instituted in order to reduce the attrition
of medical faculty has been mentoring, in one form or another. In recent years
because of attrition problems, “academic medical centers have come to appreciate
the value of mentorship for young faculty” (Gray, 1998, p. 279). In a recent study,
639 junior faculty members with mentors had “significantly higher mean ratings
of institutional support for teaching and administration” (Gray, 1998, p. 279), than
did those who did not have mentors. In a study of research scientists in
departments of medicine, “having a mentor is cited as the single most important
influence in their decision to undertake a research career” (Papp & Aron, 2000, p.
408). Another study found a link between being mentored and successful career
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4 7
advancement (Cawyer & Simonds, et. al., 2002, p. 226) 43% of Kober Medal
recipients of the Association of American Physicians referred to their mentors
while accepting awards, a “strong affirmation of the importance of mentors in
shaping an academic career” (Papp & Aron, 2000, p. 408). Also, another study
found that “junior faculty with identified mentors tend to publish more articles,
have better employment opportunities, feel more confident about their capabilities
and are, on the whole, more satisfied with their careers” (Gray, 1998, p. 279).
Finally, 75% of junior faculty and 89% of senior faculty rated as positive the
impact of participating in a mentoring/preceptoring program on their careers
(Benson & M orahan, et. al., 2002).
In the basic sciences, mentoring has been traditionally used to increase
faculty productivity in terms of research and teaching. This orientation influences
the implementation of mentoring in other professions, including psychology,
medicine and nursing. Mentoring is expected, in this hard science context, to help
the junior faculty member improve his or her research and teaching skills, and
meet institutional tenure requirements (Paul & Stein, 2002). Thus, mentoring
serves to counteract the deleterious institutional factors which repress
productivity, including the availability of funds, release time, chair or dean
support for research, and the availability of computing or statistical help (Paul &
Stein, 2002). But in this context, studies of mentoring have shown it to have
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improved employee motivation, job performance, a sense of organizational
continuity, and better retention rates (Benson & Morahan, et. al., 2002, p. 550).
Another study reports that mentoring also increased intellectual
stimulation in the junior faculty. M ost importantly, mentoring is intended to help
junior faculty members “take charge of their professional growth and
development” (Benson & Morahan, et. al., 2002, p. 551). This is especially true in
a research environment, where mentors are tasked to help junior faculty through
the research environment (Hollingsworth & Fassinger, 2002, p. 326).
Though all of these practical studies indicate that mentoring has reduced
attrition rates at medical schools, mentoring at a medical school remains in an
academic context, which greatly complicates its implementation. In this area of
the literature, mentoring finds itself unsupported by data, as “there are relatively
few empirical studies of the mentoring of professors” (De Jansz & Sullivan, 2002,
p. C l). There are several reasons why a dearth of academic faculty mentors
persists. First, it is often assumed that young faculty members do not require a
mentor because of their educational background. Second, it is assumed that the
faculty m em ber’s prior work on their dissertation entailed a mentor-like
relationship with their advisor, thus precluding the need for assigning another
mentor. Finally, it is assumed that faculty members have all had the experience of
being apprentices, and thus need no further guidance (De Jansz & Sullivan, 2002,
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49
p. C l). This has little application to those graduate students in fields such as nurse
anesthesia which primarily focus on the clinical patient care aspects.
In addition to this perception, academic administration also often
overlooks the need for mentoring. W hile in business one deals with positions held
by people with different levels o f education, thus necessitating mentoring to
negotiate changes in the organization, academics by and large experience similar
educational levels, and many often move over into administration, yet retain an
understanding for the faculty (De Jansz & Sullivan, 2002). This reduces the need
for mentors. Finally, with a career ladder consisting of three rungs only, assistant,
associate and full professorship, there is less need for a mentor to explain the ins
and outs of complicated hierarchies and promotions (De Jansz & Sullivan, 2002,
p. C l). As a result of these limitations, an interview of mid-career faculty revealed
that many “didn’t believe they needed mentors” (De Jansz & Sullivan, 2002, p.
C l).
In addition to these limitations, mentoring in the academic context remains
“one of the most poorly recognized and unacknowledged of the academic duties”
(Papp & Aron, 2000, p. 408). It is a rule of thumb among faculty that taking on
too many mentees, either junior faculty or students, “is perilous to one’s academic
career” (Papp & Aron, 2000, p. 408). In the medical field, “the teaching and
mentoring of m edical.. .residents, once viewed as gratifying, has become a
hindrance to clinical income expectations” (Pololi & Dennis, et. al., 2003, p. 21).
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50
Thus, the historic inadequacy of academic mentoring and the current crunch in
medical school life converge to repress the mentoring urge of physician faculty
who, in fact, joined the academic side of medicine to engage in mentoring or
teaching (Pololi & Dennis, et. al, 2003, p. 21).
W ith all of this information on mentoring, junior faculty members in
medicine repeatedly report the need for mentoring (Pololi & Dennis, et. al., 2003).
The literature generally supports the “positive effects of m entoring.. .used as a tool
for faculty development in health” (Paul & Stein, 2002, p. 2). Close physical
contact of senior and junior faculty members in the preparation of a research
project is deemed to greatly impact a junior faculty m em ber’s ultimate job
satisfaction (Papp & Aron, 2000). Such research collaboration allows both senior
and junior faculty to spend more time doing what they love, approved by an
increasing number of administrators as the best way to reduce attrition (Pololi &
Dennis, et. al, 2003). M entoring also helps junior faculty with career development,
as it is only through mentoring that junior faculty discover the unwritten rules of
the campus or department, which allow them to progress in their careers (Cawyer
& Simonds, et. al., 2002). Indeed, the most important aspect of professional
advice in the mentoring context, according to junior faculty members, was
communication that explained “the internal workings of the department” (Cawyer
& Simonds, et. al, p. 234). W hen asked what their ideal situation in medical
academia would be, respondents from the junior faculty indicated that having
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51
more support from their colleagues, and a strong mentor relationship with a
colleague would be included in their ideal (Pololi & Dennis, et. al., 2003, p. 5).
Many senior faculty members who mentor also believed that mentoring revitalized
them, offered them input as to their own career goals, and caused them to desire
mentors of their own (Pololi & Denni, et. al, 2003).
W hile mentoring has been reported to be effective in helping academics
navigate the more complicated byways of career development in medicine or other
fields today, more and more focus is being placed on faculty mentoring for the
help it offers junior faculty in terms of socialization. M entoring is now commonly
recommended as a strategy to promote the socialization of younger medical
faculty (Bower & Diehr, et. al., 1998). Interviews with junior faculty reveal that
many feel overwhelmed and isolated in their new academic life, and as a result
focus at first on logistical and tactical problems, “leaving strategic career planning
to later” (Benson & Morahan, et. al., 2002, p. 556). How easily a new faculty
member adjusts to academic life, or whether he or she adjusts at all, is believed to
depend on the “type of relationships that the newcomer establishes with
colleagues” (Cawyer & Simonds, et. al., 2002, p. 224).
If good mentoring relationships are established early, it is found that
socialization is facilitated (Cawyer & Simonds, et. al., 2002). Others argue that it
is better in some fields, and medicine is suggested, to forego the traditional single
mentoring relationship, and seek out multiple relationships as a network
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throughout the department. A study of the peer relationships established by a
faculty member found both informational and collegial peers, that is, some people
one goes to for information, others one establishes trust with (Quinlan, 1999). One
needs to simultaneously connect with influential members of the discipline,
cultivate political ties with more experienced members of the department and
school, and gain “psychosocial support for the unique career challenges they face”
(Quinlan, p. 38). Potential mentees must use an array of communications tactics to
signal their identity, their performance and their social capital, in order to
negotiate this network (De Jansz & Sullivan, 2002). In sum, professors and
academics need to develop a “portfolio of mentors who can help them develop
across a variety of learning experiences and over the phases of their careers” (De
Jansz & Sullivan, p. C6). Such a network of multiple mentors will help a junior
faculty member gain assistance in completing research projects, develop teaching
skills needed for tenure, and obtain written recommendations also needed for
tenure (De Jansz & Sullivan, 2002).
W hile generally, Bower & Diehr, et. al., (1998) acknowledge that the
mentoring literature describes the functions, roles and responsibilities of faculty
mentors, reports “fail to specify the types of mentor-protege interactions that
would optimize protege career development in academic medicine” (p. 595).
Overall, “there is no literature identifying the key features of effective mentor-
protege interactions in academic medicine” (Bower & Diehr, et. al., p. 595).
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53
Derived from the literature on mentoring for adult education, three key elements
of a successful faculty mentor have been identified: support, challenge and a
“vision of the protege’s future” (Bower & Diehr, et. al., p. 595). Support involves
affirming the value of the individual through respect and trust, or by setting clear
expectations and providing resource materials. But mentors must also challenge
their protege to counter incorrect assumptions, and force the protege to reflect
upon his or her values, competencies or vision (Bower & Diehr, et. al., 1998). By
acting as a role model, the faculty member sets a vision about the future in the
protege’s mind as well. “By balancing challenge, support, and vision the mentor
creates the tension essential for change and growth” (Bower & Diehr, et. al., p.
595). This kind of focus has been influential in establishing mentoring programs
in medical contexts across the country. A mentoring program for junior faculty at
a W isconsin Medical College was successful in socializing junior faculty, by
promoting career development (and retention) and by fostering collaboration with
colleagues (Bower & Diehr, et. al., 1998).
An increasing problem in medical academic contexts, with relevance to
nursing, is the additional problems faced by women or minorities. Research has
indicated that mentoring is essential in order for women to overcome the many
barriers to career progress that they face. In one study “women who were
mentored in their faculty role were more likely to feel self-confident and to
possess a positive attitude about fulfilling the requirements for tenure and
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5 4
prom otion” (Cawyer & Simonds, et. al., 2002, p. 224). For women especially, it is
important to understand, from a gender point of view, the politics of the
organization, the skills and competencies needed to take important steps forward,
the paths to advancement, and “the acceptable methods for gaining visibility in the
organization” (Quinlan, 1999, p. 31). The fact that most mentors are male raises
specific problems for women. According to one theory, humans are homophiles
and best take under wing and help those who are like them: thus men mentoring
women, sexual politics aside, is a problem (Quinlan, 1999). Academic women
from the beginning of a new position first experience more isolation in academia,
because it has been traditionally such a bastion of male power. Also, women need
to be more active in selling and legitimizing themselves in the male organization
(Quinlan, 1999). Moreover, even the literature on mentoring is male-oriented,
usually describing the mentoring relationship as involving males progressing
“linearly along a single career trajectory, starting as a young, recent graduate and
moving to a peak or a plateau” (Quinlan, 1999, p. 32). This is a male idea of a
career, never interrupted by marriage or children. Finally, the one-to-one nature of
traditional mentoring appears to go against the grain of the networking impulse of
female organizational behavior, ever seeking of “career-supportive relationships”
(Quinlan, p. 33). All of these differences, the idea of mentoring “make it difficult
for senior men to understand and provide the support required for women to
advance in their careers” (Quinlan, p. 32). The impact of poor mentoring on
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55
women faculty is borne out in studies that show that, starting from an equal
academic level, “far fewer women than m en...achieve full professorship” (Gray,
1998, p. 280). A study of why this was so revealed that women “did not negotiate
as well as men in defining their initial appointment,” (Gray, p. 280), and thus took
on too much teaching and had less protected time for research. Because statistics
indicate that more women than ever are entering into various medical fields,
including some, like surgery, previously less attractive to women, the disparities in
mentoring in a male culture must be addressed (Gray, 1998). It is recommended
that junior women faculty receive mentoring with a special emphasis on
establishing their research goals, publishing original research, mastering grant
writing, and managing their time better (Gray, 1998).
W omen and minorities are especially needed on the faculty of academic
medical centers. These institutions cannot break down ethnic communication
barriers or gain fresh perspective on research process, often based on gender or
race-based disparities in healthcare, without the input of young female or minority
faculty (Wong & Bigby, et. al., 2001). Many medical centers have instituted
special mentoring programs for their female and minority junior faculty. The
programs—ranging from informal networking to facilitating mentoring programs
discussing career progress— have increased women and minority enrollment. At
present 40% of all faculty at one medical center were female, though women still
lagged behind in placement on key committees at the institution (W ong & Bigby,
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5 6
et. al., 2001). Also, at present, women continue to lag behind men in the
likelihood of their being appointed full professor, and in salary (Wong & Bigby,
et. al., 2001). It is recommended that academic medical centers continue to
diligently track the success of women and minority faculty in order to maintain the
positive trend.
All in all, it appears that mentoring has entered more into the faculty
context, and that mentoring is having an impact on reducing junior faculty
attrition. That mentoring helps junior faculty be more productive, in terms of the
demands of teaching and research, is indicated by numerous studies (Paul & Stein,
2002). In a study of the research productivity of senior and junior faculty members
from 20 nursing colleges around the United States, it was determined that
“working directly with junior faculty members on projects significantly increased
the productivity of both senior and junior faculty” (Paul & Stein, p. 24). In a
questionnaire of 309 women faculty employed full time at a nursing graduate
school it was found that mentoring occurred in 55.7% of the cases, that mentoring
was related to higher productivity, and that the length and time and type of support
involved in the mentoring also influenced productivity (Paul & Stein, 2002). The
longer the mentorship relationship, the more productive it was. Mentoring during
the early phases of a faculty career “increased productivity through sponsoring the
men tee’s ideas and including the mentee on research teams” (Paul & Stein, p. 25).
In another study of 114 males, 67 of whom were mentored, the positive impact of
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mentoring was on the social and not the research side of the job satisfaction
equation (Paul & Stein, 2002).
Overall, one derives a stressful picture for nurse and nurse anesthesia
education, with too many educational programs having closed, and the clinical
side of education seemingly enamored of short-cuts offered by technology. At
present, the anesthesiologist shortage pulls anyone who has experience in the field
toward profit. W hile the volume of surgery and technical and pharmacological
advances overwhelm all practitioners to the extent that the human element— and
true mentoring-is edited out of the process, practice still appears to be more
attractive than education of practitioners.
The attrition of educators is echoed in cited instances of attrition elsewhere
in the field. It has been mentioned that nursing anesthesia students suffer attrition
when they enter the clinical phase of their practice (Waugaman & Aron, 2003).
Another instance of attrition has been noted in economics regarding the further
specialization of the field. An important trend in anesthesia is that more
practitioners of general nursing anesthesia are moving into subspecialties such as
pain management and critical care, because “they offer better compensation and
working conditions” (Roland & W offord, 2003, p. 67). It has also been noted that
more anesthetists are moving from hospitals to office-based surgical settings for
similar reasons— offices afford them more control over their affairs, less billing
problems, thus more profit, not to mention a closer relationship with their
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surgeons (Hornsby, 2002).
In order to halt this attrition, hospitals have begun to offer anesthetists
increased compensation and contracting exclusivity, to guarantee them a
profitable volume of jobs (Rowland & W offord, 2003). The self-sufficiency of an
anesthesia practice, with little clinical space or clinical equipment taken up,
allows them to move as they wish, a fact which has “an extremely destabilizing
effect if compensation and working conditions at one hospital become
inconsistent with market conditions” (Rowland & Wofford, p. 68). This problem
is exacerbated because administrators often do not understand the market
conditions in which anesthetists are operating (Rowland & Wofford, 2002).
Once a clinical nurse anesthetist begins to practice, moreover, he or she is
motivated to act on economic grounds, because the education they received has a
total cost that excels most other specialties in graduate school (Heikkila, 2002).
The cost of their education undoubtedly influences their attrition behavior once in
the field (Heikkila, 2002). Moreover, it seems highly unlikely that he or she will
go into the educational side of the field, and, if so, that the decision to teach will
not be final, or even long-term, but controlled by market conditions and demands.
One solution which some institutions have tried in order to stabilize the volatile
nurse anesthesia marketplace— with anesthetists moving into specialties, jum ping
from one hospital to another, moving to office-based practice, and leaving the
educational side of the field in the dust of the for-profit opportunities created by
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59
the shortage— is to fund in advance the education of a future employee, who has
thus signed a contract for coming to the funding hospital (Heikkila, 2002).
W hatever solutions are devised, it is clear that the high cost of nurse anesthesia
education is a negative motive pushing potential educators to seek higher
reimbursement for their investment in time.
It is believed that if the attritions attributable to the “imbalances of supply
and demand” in the nurse anesthesia market can be moderated (Oulette & Bruton-
Maree, 2002, p. 439), then the further attrition of educators and mentors can also
be stemmed. It is estimated that at present there exists a total shortage of 2,000-
2,500 academic anesthesiologists in the United States, with almost four posts of
anesthesiology and nurse anesthetist positions vacant in numerous departments
across the country (Eckhout & Schubert, 2001). This translates into a “combined
deficiency of nearly 900 positions in academic departments” (Eckhout &
Schubert, p. I). It is believed that those educators remaining could be kept in place
by managing compensation, by improving their profile in the field and by
providing them with mentoring. One researcher argues that every CRNA in the
field should take it as a responsibility to recruit more applicants, and also mentor
both faculty and students, whenever possible (Oulette & Bruton-Maree, 2002).
Others argue that the clinical faculty in nurse anesthesia has to be improved
outright (Hand & Thompson, 2003). Some studies indicate that faculty mentors in
nurse anesthesia are inadequately prepared, as is true of nursing in general
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(Andrews & W allis, 1999). Changes in accreditation, program length and other
aspects of nurse anesthesia education are also proposed (though many are disputed
by the existing faculty) (Ouelette & Bruton-Maree, 2002). Many solutions are
offered, but at present the attrition rate of educational mentors in nurse anesthesia
appears to be subject to larger forces that must first be moderated, before
vacancies and weaknesses in education and mentoring in the field can be
redressed.
Conclusion
This review of literature has shown that mentoring is the primary means by
which the classroom and the clinic can be brought together to reduce the
continuum of attrition among faculty. Numerous problems in the definition and
implementation of mentoring in nursing were shown, even if the enthusiasm for
mentoring appears to broadly leading to positive outcomes in terms of the
improvement of the clinical practice of nurses working under mentors (Dingman,
2002; Gray & Smith, 2000; Jones & Walters, et. al., 2001; McWeeney, 2002). The
problems cited in implementing true mentoring in nursing appear to evolve into
roadblocks when faced with the difficulties related to technological and
pharmacological advances in the sub-field of nurse anesthesia. These problems
suggest that the achievement of true mentoring, and a smooth transition of
students from the classroom to the clinic remains a problem in nurse anesthesia,
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61
and, indeed, as the attrition rates of students at just the point they enter the clinical
arena indicates, lags far behind nursing in general (Myer & Martin-Sheridan,
2003). M entoring in the academic context brings with it a host of additional
problems, to the needed mentoring of junior faculty so that they will stay in
education and not jum p over, motivated by forces related to the shortage of
anesthesiologists, to practice. A severe shortage of nurse anesthetists has
distorted the entire marketplace in which educators and practitioners alike work.
Flooded with money, but with practitioners choked by overwork and an overall
sense of lack of time for the humanity of their patients, and educators dismayed by
how economics has denigrated teaching, the field has witnessed erosive attritions
from the field into sub-fields, from hospitals into office-based settings, and from
education into practice (with hospitals themselves closing down educational
problems or ending affiliation with academic programs due to cost issues).
Money, indeed, is a prime reason for many to rush into the field, but only
those who truly appreciate the difficulties of the specialty survive. Therefore, the
attrition of academic faculty into the practice of nurse anesthesia itself may be
conveniently rationalized by the attraction of more money, but appears to be
rooted in the anti-educational biases of the imbalances of the marketplace, and,
indeed, in the lagging behind of mentoring in the field as well. Perhaps the frantic
nature of the marketplace, with demand far outstripping supply, has temporarily
suspended the hopes of educators in the field that they can obtain their educational
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6 2
ideals, and they have thus decamped to practice and profit and placed their
educational ideals, for the moment, on hold. In the meantime, an impression given
by the literature, and limited suggestions about how to address the problem
concur, is that the educational side of the nurse anesthesia field has been
dismantled by the marketplace imbalance and needs to be overhauled in the years
to come to prevent the occurrence of another anesthetist shortage.
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63
CHAPTER 3
METHODOLOGY
This chapter includes the research questions, a description of the research
methodology, the sampling procedure and population, instrumentation, and
procedures for data collection and analysis.
The Veterans Association (VA) of Puget Sound Health Care System-
Health Services Research and Development of University of W ashington, Seattle-
School of M edicine has been a leader in faculty mentoring. They developed and
documented in the 1990’s an individual assessment questionnaire that facilitated
the University Medical school in developing an internal mentoring program and
has helped in the retention of more medical faculty members over the past ten
years.
The questionnaire used in this study was redesigned and adopted from the
VA Puget Sound Health Care System-Health Services Research and Development
of University o f Washington, Seattle- School of M edicine Faculty Mentoring
Questionnaire (FMQ) template with written permission. (L. Chew, 2003) The
research tool was adapted for the faculty within nurse anesthesia graduate
programs. The questionnaire was approved by the Institutional Review Board
(IRB) of the University of Southern California. The questionnaires were mailed
via U.S. mail to all accredited nurse anesthesia program directors within the
United States as of 2003 with written instructions for dissemination to the faculty
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6 4
members. (N=120) The Program listing was obtained from the AANA Council on
Accreditation listing of programs within the United States. In addition, a follow
up letter was mailed as a reminder to all program directors asking to complete the
questionnaire.
The distinct areas within this faculty assessment questionnaire examined
the overall area of faculty mentoring including clinical aspects, scholarly work-
research publications in journals and books, and administrative areas within the
academic setting. Theses specific areas have been clearly identified in past
research as the main areas in which the nurse anesthetist faculty member works.
The far reaching question regarding whether the faculty member would leave the
academic setting within the next three years was added to examine the attrition
rate. The questionnaire was anonymous and did not have any individual
identifiers.
Demographic questions included only age, geographic location of the
program, gender, race and degrees held. The faculty information section of the
questionnaire included title, status, number of years as a faculty member, faculty
track and any formal post-graduate education in areas of research, teaching or
administration.
Section three or the time allocation section, focused on the percentage of
time allocated, percentage of time actually spent, and ideal time in areas of
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scholarly work, direct patient care, supervising and teaching students and finally
administration.
In section four, Faculty Skills Self-Assessment, both short term and long
term goals were addressed. On a Likert rating scale of 0-10, the participant rated
the importance of each skill area based on their career goals. In tandem with this
importance level— and also utilizing the same Likert rating scale— respondents
were asked to assess their confidence in this particular personal skill area. The
final area within this subsection asked the faculty member to indicate by utilizing
an “X ” if they desired training in any of the particular skill areas indicated.
The importance and confidence areas were then broken down into
subsections including patient care skills, teaching skills, research skills,
management skills, and scholarly work skills. The final section of the research
involved a qualitative look at short and long term goals of individual faculty
members. Themes were extracted from many of the respondents which became
part of the qualitative findings. These findings were highly unexpected however,
provided additional reinforcement to the need for a formal mentoring program.
The Faculty Self-Assessment agreement section included areas such as
promotion awareness, short-term and long-term goals achievement, conducting
research, providing patient care, and time management as well as mentorship.
This area examined the responses on a one to five rating scale where one equaled
“strongly disagree” and five indicated “strongly agree.” The final four questions
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examined research grant proposals, peer-review journal writing, book publishing,
and development of curricula/syllabi for nurse anesthesia students or faculty.
Fifty percent (50%) of the questionnaires were returned to the researcher
via the postage paid enveloped provided in the initial mailing (N=60). Descriptive
statistics and Chi square analyses were performed for all variables utilizing the
Statistical Package for the Social Sciences (SPSS) 12.0.
A descriptive design was used in this study, with a sample that included
program directors from all accredited NAEP within the United States as of 2003.
A method of document analysis was employed to describe systematically the
characteristics of faculty members within a graduate program specializing in nurse
anesthesia. This method was used to collect detailed ongoing factual information
about current conditions and practices among nurse anesthesia faculty members
regarding mentoring. The critical aspects of this research were to determine what
faculty members are doing in similar situations regarding mentoring and from
these experiences to develop a mentoring plan for the future.
The survey or questionnaire technique is the most widely used tool in
education and the behavioral sciences for the collection of data. The data could
yield specific target areas which could provide the underlying foundations for
development of a mentoring program for faculty within nurse anesthesia
educational programs.
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Characteristics for this questionnaire included a systematic approach for
content, inclusion of all accredited nurse anesthesia educational programs as of
2003, objective data points utilizing a Likert scale where applicable, and finally,
data expressed in numerical terms where possible. The Likert scale was utilized
for certain areas of the questionnaire with approximately the same weight.
Obvious limitations to the questionnaire design include participant cooperation
and possible biased reactions to certain areas in which some respondents could
score high or low based upon their “feelings” at that particular time when
completing the questionnaire. W hile questionnaires are inexpensive to deliver,
some significant disadvantages include low response rates, no assurance the
questions were understood, and no assurance that the data were actually obtained
by multiple respondents.
The questionnaire for this investigation (Appendix A) was developed
using the VA Puget Sound Health Care System-Health Services Research and
Development of University of W ashington, Seattle- School of M edicine Faculty
Mentoring Questionnaire template with written permission. (L. Chew, 2003) The
questionnaire was adapted to faculty within nurse anesthesia graduate programs
and areas which would be pertinent to the research questions. The scale items in
the questionnaire were modified from C hew ’s original instrument. The Program
listing was obtained from the Council on Accreditation of Nurse Anesthesia
Educational Programs (NAEP) within the United States in 2003. The instrument
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was submitted to the University of Southern California University Park
Institutional Review Board along with the proper documentation and was
approved in 2003.
In August 2003, the questionnaires were mailed to all nurse anesthesia
program directors including a cover letter with written instructions for
dissemination to the faculty members. (N=120) (Appendix A). In addition, a
follow up letter was mailed two weeks later as a reminder to all program directors
to complete the questionnaire. All questionnaires were numerically coded to
assure each participant’s anonymity. Of the 120 questionnaires, 60 responded.
Instrumentation
The Faculty Self-Assessment Survey was comprised of 65 questions and
statements. Questions one through six identified demographic data. Questions
seven through fifteen described faculty information within the academic
institution. There were no personal identifiers within any section o f the
questionnaire. Questions 16, 17, and 18 defined time allocations for the four
distinct skill areas which are the foundations to this instrument. These distinct
areas of the questionnaire examined clinical aspects, teaching/supervision, and
scholarly work including publications in journals and books, and administrative
activities common to all health care academic settings. Theses specific skill areas
have been clearly identified in past research among medical and nursing
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mentoring programs. It is these specific skill areas which provide the foundation
of this research.
Questions 21 through 48 rated the importance of each skill area based on
the participant’s career goals. A Likert Scale of zero meaning “not important” to
ten meaning “critically important” was utilized throughout this section. In this
skill area section of the instmment the individuals were asked to indicate
confidence level on these same personal skill areas. The final component to this
section addressed whether the individual desired training in any of the particular
area. This portion was scaled only with a yes indicated by “X ” and no desired
training remained unmarked.
In the section of Faculty Self-Assessment, questions 49 through 59
individuals were asked to select the extent of agreement in a statement format.
This area included a scale where one equaled “strongly disagree” and five was
equaled to “strongly agree.” Included in this area was a foundation question
regarding mentorship which was then examined in the final section of the
questionnaire. The middle section of the questionnaire, questions 19 and 20, were
open ended, asking for the participant to write in their short and long term career
goals.
Fifty percent (50%) of the questionnaires were returned via the postage
paid enveloped provided at the initial mailing. (N=60) Returned questionnaires
were collated in the order that they were received. Utilizing SPSS 12.0,
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descriptive statistics were performed for all variables as well as Pearson
correlations between variables.
Validity and Reliability
Content validity of this research is shown by sections 2, 3, & 4 in which
the classification of patient care, scholarly work, teaching, research, and
administration are examined. Reliability means the consistency of scores between
measurements in a series. In this research, the 4 underlying themes of scholarly
work, direct patient care, supervising/teaching and administration were examined
in many different formats.
Survey research is generally weak on validity and strong on reliability
(Babbie, 2001). Questionnaires are forms of measurement that should meet the
same standards of validity and reliability as other evaluation measures in
education. Construct validity is the extent to which a particular test can be shown
to assess the construct that it purports to measure (Gall, Borg, & Gall, 1996).
Data Analysis
All data were entered into SPSS statistical programming version 12.0.
Missing values (N=3) in certain areas and were replaced by the series mean
method. There were three stages to the analysis of this study. The first stage of
analysis was descriptive. In this stage the mean, standard deviation, and
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frequency were determined (Questions 1 and 2). Chi square (x2) is a means of
answering questions about data existing in the form of frequencies rather than as
scores or measurements along some scale. This technique examines the
probability of correctly responding to the questionnaire from different groups with
the same ability levels. In this research, all faculty members are assumed to be of
the same abilities as faculty members within the specialty of nurse anesthesia.
The chi square (x2) approach to test item bias is sensitive to within groups’ item
discrimination in addition to the differences between groups in item difficulty
levels. In addition, the individual events or measures are independent of each
other. The frequencies refer to the categories in which the research has classified
as data.
For example, in this case, the demographic data were analyzed
utilizing this x2 adding “number of years as a faculty member” in section one.
The classification pattern for this distribution was grouped in four distinct groups.
Group 1 was one year or less, group 2 was 2-5 years, group 3 was 6-10 years and
group 4 was eleven or more years as a faculty member. The groupings did not
take into account whether the faculty member had multiple academic positions or
had been employed at multiple academic institutions during the years
documented. Again looking at the independent variable of adequate mentorship, a
chi square (x2 ) analysis was performed with these specific groupings. The
independent variable of number of years had no statistical significance indicating
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that it did not matter on the number o f years as a faculty member where adequate
mentorship was concerned. There was no distinction between a junior or senior
faculty m em ber’s responses to the statement “I have adequate mentorship” .
To answer the fourth research question regarding allocated-ideal time
spent, a comparative analysis was used for each individual category: scholarly
work, direct patient care, supervising/teaching and administration. These four
themes are continuous variables throughout this research. Differences between
allocated time, actual time and ideal time are examined. The chi square (x2 ) again
was used to test differences between groups in item difficulty levels.
Research question 2 asks “Is there a significant relationship among nurse
anesthesia faculty m em bers’ long and short term goals and intention to leave the
profession?” Held within the questionnaire are several areas which address this
question. The final question to the questionnaire (# 65), asks what is the
likelihood that the faculty member will leave? Answer number one is to seek
employment at another institution, second answer is to seek employment in the
clinical setting and the third is to seek employment in another field. Finally,
answer number four is to retire. In addition to this question is the qualitative area
in which the participant describes their short and long term goals.
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CHAPTER 4
FINDINGS
The purpose of this study was to investigate mentorship and its availability
to nurse anesthesia faculty members as well as examine if mentorship in the four
skills areas was identified as significant for the high attrition rate among faculty
members. The population included faculty members within accredited nurse
anesthesia educational programs as of 2003 (N=60). It did not include those
clinical faculty members whose sole position is clinical instruction of the graduate
students at hospitals. Clinical faculty members may have a courtesy adjunct
professor status with the academic institution, however, have limited or no
participation in program didactic teaching or administration activities.
Chi square (x2) analysis was used as well as descriptive analyses utilizing
SPSS 12.0. An analysis of variance (ANOVA) was not reported within this
research because the group variances were not homogenous; therefore,
comparisons of significance of means were inappropriate.
Demographic data of the respondents were derived from questions one
through six. Each category was analyzed using descriptive frequencies. This
descriptive information from the frequencies serves to describe the characteristics
of the faculty members and is used for the remainder of the analysis. In a report
from the Foundation of the AANA in 2003, the average age of the CRN A is 47
years. They have estimated that the average age will continue increasing at 0.14%
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7 4
per year and peek at the age of 48.2 by 2018. This could have significant
implications for long-term retirement rates.
Interesting findings to this research include the mean faculty age of 45
years. This indicates that a younger faculty exists within the university academic
setting as compared to the national population of 30,000 CRNA practitioners.
Additional demographic information include 46.7% (28) respondents are male and
53.3% (32) are female. This is in keeping with the national data on gender within
the profession where females lead. In the past two decades, males have increased
within the overall profession of nursing as well as the nurse anesthesia specialty.
Table 1. Faculty age
N M ean Deviation Std. Error
Mean
Age 60 45.28 0.486 0.966
Additional demographic information regarding the number of years at
current academic rank revealed the mean number of years to be 4.24 with a
standard deviation of 3.899 years. In addition, 13.3% (8) faculty members were in
their current rank one year or less while 53.3% indicated they were in their
position seven years of less. Indeed there was no significance between the number
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of years held in a faculty position and the adequacy of faculty mentoring,
(hypothesis #1 with additional variable of years at current rank)
Table 2. Years at Current Rank
N M inimum Maximum Mean Std. Deviation
Num ber of years
at current rank
60 0 9 4.24 3.899
Table 3. Number o f Years as Faculty
Number of Y ears Actual Number Valid % Cumulative %
1 13.3 13.3 13.3
2 3.3 3.3 16.7
3 3.3 3.3 20.0
4 8.3 8.3 28.3
5 6.7 6.7 35.0
6 10.0 10.0 45.0
7 8.3 8.3 53.3
8 5.0 5.0 58.3
9 3.3 3.3 61.7
10 5.0 5.0 66.7
11 1.7 1.7 68.3
14 1.7 1.7 70.0
15 3.3 3.3 73.3
17 3.3 3.3 76.7
18 5.0 5.0 81.7
19 3.3 3.3 85.0
20 3.3 3.3 88.3
24 1.7 1.7 90.0
25 6.7 6.7 96.7
30 1.7 1.7 98.3
31 1.7 1.7 100
Total 60 100
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Along with these background data on age was the demographic
information regarding years as a faculty member at large. The data revealed
53.3% of the faculty members have been in an academic faculty position for seven
years or less. Not examined in this investigation is the notion that the faculty
member may have been at more than one institution prior to this research. In
examining the issue of “academic tenure” in general, seven years is the timeframe
in which most academic faculty members achieve tenure at one institution. This
could be a contributory factor for long term career commitment within nurse
anesthesia educational programs; however, this survey did not specifically ask a
question regarding tenure or tenure track within their existing employment.
Table 4. Highest Degree Held
Degree Frequency % Valid % Cumulative %
MS 24 40 40 40
MSN 11 18.3 18.3 58.3
PhD 14 23.3 23.3 81.7
M A 3 5.0 5.0 88.7
Ed.D 2 3.3 3.3 90
Other 6 10.0 10.0 100
Total 60 100 100
In reviewing the overall academic degrees held by the faculty members,
26.6% of the respondents held doctoral degrees and 63.3% held a m aster’s degree.
In a report from 2003 in which the Council on Accreditation of Nurse Anesthesia
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Educational Programs mandated that Program Directors and faculty members
would have doctoral degrees by 2014. In reexamining this mandate, the attrition
rate and retirement rate over the next 10 years would prohibit this from ever
becom ing a reality. W hile 26.6% of the respondents hold doctoral degrees, many
also answered they were seeking or completing a doctoral degree as either short or
long term goals in the qualitative section three. The mandate from the COA in
2002-3 may have stimulated the increased enrollment for those academic faculty
seeking doctoral degrees prior to this research.
Unfortunately the data revealed a high rate of faculty members leaving
their positions. Thirty-five percent of the respondents indicated they would leave
their current position. Reasons for leaving include: leave for a different
institution 23.3% (14), leave for a clinical position 11.7% (7), leave for a job in
another field 1.7% (1) and leave for retirement 11.7% (7).
Table 5. Faculty members Leaving Academic Position
Valid Frequency % Valid % Cumulative %
No (0) 39 65.0 65.0 65.0
Yes (1.0) 21 35.0 35.0 100
Total 60 100 100
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Table 6. Reason fo r leaving Academic Position
Leave fo r
different
Institution
Leave for
Clinical
Position
Leave for
job in
another field
Leave for
Retirement
No 73.3 % (44) 81.7% (49) 91.7% (55) 88.3 % (53)
Yes 23.3 % (14) 11.7 % (7) 1.7 % (1) 11.7% (7)
Maybe 3.3 % (2) 6.7 % (4) 6.7 % (4) 00
Total 60 60 60 100
W hile the leavers of the academic world of nurse anesthesia education
continue to indicate that faculty members would leave for another institution, it
does not indicate they would leave the profession for a different field. Leavers for
a different institution could indeed be an indication for an appropriate mentoring
program within each institution for the long term commitment.
To answer the first foundational research question regarding mentoring
and its availability within the academic setting, the answer regarding mentorship
was collapsed into three sections. The table below answers the statement: “I have
adequate m entorship”. (Question #58)
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Table 7. Adequate Mentorship
Valid Frequency % Valid % Cumulative %
1.0 Strongly
Disagree/Disagree
19 31.7 33.3 33.3
2.0 Neutral 14 23.3 24.6 57.9
3.0 Agree
Strongly Agree
24 40.0 42.1 100
Total 57 95.0 100
Missing 3 5.0
Total 60 100
Total number of participants answering this question equals 57. Three
respondents did not answer this question. SPSS 12.0 was utilized for all
statistical analyses performed. The above table examined the adequacy of
mentoring for faculty members based upon agree, neutral, or disagree status. This
primary question was the foundation for all other analysis within this research.
Overall, thirty-three percent (33%) strongly disagree or disagree that they have
adequate mentorship in their current academic positions. Twenty-five percent
(25%) responded in a neutral position where they neither agreed nor disagreed
with the statement “I have adequate mentorship.” Forty-two percent (42%) agreed
that they have adequate mentorship.
Research question number three examines the relationship between
importance and confidence of the four major academic areas in question. Each
area was divided into specific parts or items which are more descriptive of the
overall section. Faculty members were asked to indicate their view of importance
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80
and confidence in these areas utilizing the Likert scale of 0-10 where 0 equals not
important or not confident and 10 equals very important or very confident. The
research question is as follows:
“W as there a significant relationship between the importance and
confidence of academic faculty members in areas including scholarly work, direct
patient care, supervising/teaching and administration and the attrition rates in
nurse anesthesia educational programs?” Questions 21 thru 48 were divided into
these four areas. Details of the skills and responsibilities which are important to
the faculty member were then re-evaluated in the confidence of each area.
Significance is examined at 0.05 and 0.1 values.
Table 8. Importance-Confidence-Desired Training
Direct Patient Care
Skills
Average Level of
Importance
Correlation of
Confidence
% Desired
Training
Physical Diagnosis 6.05 (3.64) .393** 21.7
Medical Knowledge 8.23 (2.36) .278* 33.3
M anagement of multiple
complex problems
8.20 (2.57) .404** 31.7
M anagement of Inpatients 7.03 (2.90) .558** 18.3
M anagement of
Ambulatory Patients
6.93 (2.93) .500** 15
Teaching Skills Average Level of
Importance
Correlation of
Confidence
% Desired
Training
1 -to-1 Teaching 8.17 (2.73) .339** 11.7
Small Group Teaching 8.57 (2.17) .483** 16.7
Curriculum Development 8.77 (1.73) .347** 46.7
Provide Constructive
Feedback
9.10 (1.61) .155 25
Teaching Portfolio
Development
7.08 (2.95) .515** 35
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81
Research Skills Average Level of
Importance
Correlation of
Confidence
% Desired
Training
Research Survey
Instrument Design
7.52 (2.31) .423** 41.7
D ata Analysis 8.07 (2.28) .395** 53.3
Grant W riting 7.35 (2.77) .176 61.7
Familiarity with IRB
Process
7.98 (2.63) .505** 28.3
W riting an Abstract 7.83 (2.58) .448** 28.3
Presenting poster at
National Conference
6.98 (3.18) .512** 22
W riting Original
Research
7.77 (2.96) .450** 33.3
Management Skills Average Level of
Importance
Correlation of
Confidence
% Desired
Training
Budget 7.25 (3.27) .439** 31.7
Personnel 7.57 (3.00)
711**
33.3
Scholarly Work Skills Average Level of
Importance
Correlation of
Confidence
% Desired
Training
Scholarly journal article
review
7.85 (2.48) .274* 26.7
Internet Browsing 7.90 (2.58) .329* 20
Literature Search 8.53 (2.14) .313* 21.7
W riting Review Article 7.95 (2.41) .246 31.7
W riting Book Chapter 7.43 (2.84) .320* 33.3
Using Statistical
Packages
7.35 (3.02) .309* 53.3
Using Reference
Databases
7.38 (2.83) .471** 43.3
Preparing Power Point
Presentation
8.60 (2.24) .612** 20
Using Electronic
Spreadsheets
8.22 (2.75) .501** 41.7
Areas of importance were indicated by higher numbers when examining
data from research question three. Overall desired training highly ranked over
50% included: using statistical packages, data analysis, and grant writing. These
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82
activities are unique to the academic arena and are not part of the overall practice
in clinical anesthesiology or the current entry level M aster’s educational design.
The significance to this data is that each area indicated as highly important with
additional low confidence and desired training is a clear indication where
mentoring areas could be focused. Knowing which areas are considered
important to faculty members regardless of academic appointment, number of
years as faculty, or short or long term career goals could enable future programs to
be established and implemented.
Those faculty members desiring training in the mid range level or from 40-
49% include using reference databases, using electronic spreadsheets, research,
survey and instrument design and curriculum development. Each of these areas is
also part of the overall job description for a faculty member within a nurse
anesthesia educational program and not a priority for those within the clinical
practice arena.
Faculty members indicating a low level desired areas which were from 0-
39% include preparing power point presentations, writing skills such as articles or
book chapters, and clinical teaching skills including providing constructive
feedback. Those elements in this low desired category are commonly seen skills
currently within nurse anesthesia educational programs. Students commonly
provide written articles, or power point presentations within their nurse anesthesia
program, however, those highly desired skills are found primarily within a
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83
university setting. Hospitals and specific anesthesiology departments may indeed
help in the clinical teaching skills as well as providing students with constructive
feedback, but have no real interest in research or grant writing as indicated by the
results of this research.
Faculty members are dedicated in teaching graduate students within
anesthesiology education to provide clinical skills and safety to patients.
Historically, programs in both nurse and physician anesthesiology have been
tunnel vision to the area of clinical application and less responsive to those who
teach at the university level hoping to make the educational impact. Universities
are unaware or resistant to make the appropriate accommodations for mentoring
programs within the medical and nursing fields. Time commitment from the
university as well as the mentors themselves becomes an issue. Time allocations
for faculty members within the medical and nursing disciplines have been fragile
at best. Looming in the background is the fear of unproductive time spent with
faculty mentoring when the university demands financial support including patient
care.
To answer research question #4 of this study, respondents were to indicate
their time allocations for the four major areas; scholarly work, direct patient care,
supervising/teaching and administrative activities. Three distinct questions
include time allocated, time actually spent doing these activities and the time the
respondent would ideally like to spend at these activities. These expectations
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84
could have a direct impact on the development of mentoring activities to meet the
needs o f the faculty members. Distribution frequencies between these three areas
are indicated in the next tables below.
Table 9. Time Allocated vs. Time Actual
Skills Area Below (-) Zero Above
(+)
Scholarly work 8.3 (5) 66.7 (40) 25 (15)
Direct Patient Care 20 (12) 71.7 (43) 8.3 (5)
Supervising/Teaching 16.7(10) 61.7 (47) 21.7
(13)
Administration 16.7(10) 68.3 (41) 15(9)
Other
In Table 9, the negative numbers indicate the respondent was actually
spending more time in these activities than allocated by their contract or job
description. The positive numbers or those above zero indicate that there was
more allocated time than the actual time spent. And the zero response indicates
both allocated time and actual time were essentially equal. In the comparison of
the actual time spent in the same four academic activity areas and allocated time
as indicated by the job contract, 20% (12) respondents provided more direct
patient care services, 16.7% (10) indicated they provided more
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supervising/teaching as well as administrative activities, and only 8.3% (5)
respondents engaged in scholarly work more than allocated.
Table 10. Time Actual to Time Ideal
Skill Area Below (-) Zero Above (+)
Scholarly W ork 3.3 (2) 16.7 (16) 70 (42)
Direct Patient Care 30 (18) 40 (24) 30 (18)
Supervising/Teaching 41.7 (25) 28.3 (17) 30 (18)
Administration 50 (30) 38.3 (23) 11.7 (7)
Table 10 above, examined the differences between what the faculty
members considered to be ideal percentage of time for activities compared to the
actual percentage of time spent at that activity. Numbers below zero indicated the
respondent spent more time doing more than they would ideally spend. In this
case, faculty members indicated that they spend 50% (30) of their time in
administrative activities. This is the actual percentage of time and not the ideal
percentage of time the respondent would like to be doing. W hereas, 70% (42)
respondents indicated they would ideally like to spend more time in scholarly
activities but were doing less in this area; their actual scholarly time spent was
less than ideal.
Below (-) = doing more than ideally they would do. Actual is greater than
ideal.
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Above (+) doing less than ideally they would do. Actual is less than ideal.
Table 11. Short and long term goals Qualitative Section
Written Career Goals Short Term
(2-3 years)
Long T erm
(5-10 years)
Complete Doctoral Degree 19 17
Participate/W rite Research 16 7
Publish 23 6
Clinical Practice 17 5
Grants & Funding 17 7
Administrative skills 29 38
Political Involvement Outside
University setting
3 8
Teaching Skills 20 6
Retire 14
Table 11 above was the qualitative outcomes section of this research.
Faculty members were asked to indicate their short and long term goals in a string
variable fashion. These string variables were then analyzed for internal themes
presented. Interesting findings to this qualitative section were 8 identified areas in
the short term or 2-3 year career goal plan and 9 identified themes in the long term
or 5-10 year plan.
Complementary to the quantitative research findings, 19 respondents
indicated they would like to complete or start a Doctoral program as a short term
goal. In addition, when comparing the short term goals and long term goals, both
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areas indicated a need for administrative mentoring with 29 in the short term and
38 respondents long term.
Summary
The purpose of this study was to investigate mentorship for nurse
anesthesia faculty members within the academic setting. The population included
faculty members within graduate programs specializing in nurse anesthesia
education only in 2003. The remarkably high attrition rate noted by the AANA in
2003 was the driving force for this study. Unfortunately, research question one
indicated there is limited mentoring for faculty members. In addition, those who
indicated they would leave the academic setting was higher than the national
average of 20%. The data of leavers revealed 35% for various reasons. The
reasons for leaving the academic position are in keeping with older data of
medical school and nursing faculty. The significance is the high attrition within
this study and the indicators for mentoring for the future. M entoring programs
within faculty positions of universities have taken a back seat to the financial
struggles within the university itself. Unfortunately, the expectation of actually
producing income for the university by providing patient care within the hospital
setting has showed over the expectations of ling term academic commitment.
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CHAPTER 5
DISCUSSION AND CONCLUSIONS
This chapter presents the conclusions and policy implications for
educational programs within the nurse anesthesia specialty, faculty members
within these programs, as well as for nurse anesthetists considering an academic
position. It is organized into four sections: First, the conclusions of the study will
be presented for each research question. Second, the relationship between the
findings of this study and previous literature will be discussed. Third, the
limitations of the study will be presented. Lastly, recommendations and
implications for future studies will be offered.
The purpose of this study was to investigate mentorship for nurse
anesthesia faculty members working within an academic setting. The population
represented by the sampling included faculty members within graduate programs
specializing in nurse anesthesia education in 2003. The remarkably high faculty
attrition rate of 20% per year noted by the AANA in 2003 was a critical driving
force for this study.
Research question one, examined the condition of faculty mentoring
within the academic setting. Results indicated that there was limited mentoring
for faculty members. 33% of the respondents indicated they disagreed or strongly
disagreed with the statement regarding adequate mentorship within their current
academic position. W hat was interesting about this finding was the absence of a
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significant correlation with the number of years spent as a faculty member. 53%
of the group responded that they had seven years or less within their academic
setting. The high response of disagreement with regard to the fact that they had
adequate mentoring may have come either from those faculty members with one
year or less within their current academic setting or from those with many years of
academic experience, revealing once again the lack of correlation between the
number of years as a faculty member and their percept of having received
adequate mentoring. The extant literature on the topic of mentoring clearly
suggests that a novice without mentoring in a new employment situation will not
develop to her/his full potential. The critical part of this process appears to be the
timing of the mentoring process.
Faculty members within the nurse anesthesia specialty are primarily
recm ited from the clinical arena. Those nurse anesthetists from the clinical arena
have little knowledge of academic life or needs. Senior nurse anesthetists
recruited to the academic side have the clinical qualities to provide safe anesthesia
care to all patients, however, no experience in a university setting. Senior faculty
members ranking as associate or full professor may be less vulnerable to academic
life mentoring, however, their experience may be viewed as “on the job training”
and not university mentoring. The title of the faculty member did not show
significance to the question regarding adequate mentoring in this research.
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Finally, there was no difference in the response based upon whether a faculty
m em ber was on a tenure or non-tenure track at the university.
The final analysis of this question revealed that more than one third of the
faculty members disagreed with the statement “I have adequate mentoring”
regardless of title, time spent at the academic setting, or duration of employment.
Oddly enough, one would have expected that a more experienced faculty member
would have ongoing mentoring or even provide mentoring to new faculty
members. This research did not delineate the differences of more experienced
faculty with young newly employed faculty members in nurse anesthesia graduate
programs. The significance of this outcome indicated that there was no difference
in mentoring regardless of academic rank.
In terms of the overall impact or significance of mentoring to University
administrators, one might think that there is ongoing mentoring for those of longer
employment. Again, there may be evidence of a vulnerable period of time when
mentoring could have an impact on those who stay long term or those who feel
frustrated and leave. A university administrator might think that faculty members
of higher rank do not need additional mentoring for longer job commitment,
however given the high attrition rate among faculty members in this research,
university administrators may benefit by rethinking this position. University
settings may offer a tenure track to those faculty members at the seven year mark,
however, where programs have “dual governance” between a hospital and a
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university, tenure may not be an option, at that point. In addition, many
universities do not offer tenure of any kind, but rather offer long-term contracts to
their faculty. The incentive for a tenured position may indeed be nonexistent in
dual governance settings. The university sets the standards which has an impact
upon a faculty m em ber’s focus. One example is in the area of research. If a nurse
anesthesia graduate program is housed in a tier 1 research university where
research is ongoing, faculty members will be expected to provide research as part
of their annual individual portfolio. They may be involved with more than one
research project, publication, national presentation or other activities which are
academic in nature and have little to do with the actual specialty of clinical
anesthesia practices. Again, faculty members move from the clinical setting
where they initially learned about patient care, into academic life and employment
where they have limited experience.
In some institutions specifically those with dual governance, university
mentoring may be overshadowed by the clinical precepting practices as noted in
chapter 2. This focus on clinical precepting perpetuates the viscous cycle of
inadequate mentoring at the academic level where faculty members may feel lost
and thus seek to return to the familiar comforts of clinical practice. This could be
a possible explanation for the high response rate of those who said that they
“disagreed” or “strongly disagreed” with whether they had adequate mentoring.
In this instance, mentoring is being confused with clinical precepting. The value
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of clinical precepting, as it contributes to long term career commitment has been
well researched (Faut-Callahan 2002, Horton, 1999). The confusion arises when a
clinical faculty member leaves this environment and enters the academic arena.
University structures, faculty mentoring offerings are distinctly different than the
“one-to-one” precepting provided at the hospital level. W here precepting falls off
once the task or skill has been achieved, mentoring lasts a lifetime and may
involve many different people and disciplines.
According to the Council on Accreditation of Nurse Anesthesia
Educational Programs, 18% of the 90 nurse anesthesia educational programs
operate under the dual governance model between a hospital and the degree
granting university. The 1998 mandates for all programs to be housed within an
university granting a master’s degree took more than 30 years to implement. This
leaves 82% o f the programs operating solely under a university structure. There
was no delineation in this research whether the respondents were employed in a
dual governance situation or solely within a university. This research did not take
into account that some faculty members have a “dual role” which may include
activities in the hospital setting perhaps in a managerial or clinical capacity as a
condition of their employment as well hold a university appointment. This dual
role of part clinical, part academic employment is nothing new to nurse anesthesia
education. In earlier years, academic programs were solely based in hospitals
where the educational framework was “on the job training” and the focus was
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patient care. W hat is new today are the expectations that a clinical faculty
member will seamlessly transition into an academic role from a hospital setting
with little or no mentoring from the academic program. Identifying those areas
where mentoring could potentially influence whether a professor successfully
transitions for a sustained period, or leaves the profession completely is another
foundational question for future research into the role of mentoring.
The continued clinical control of graduate programs within nurse
anesthesia education, obscures the need for mentoring within universities. The
finding from the variable for number o f years at the academic setting did not
significantly affect either those who agree that they had adequate mentoring or
disagreed that they had adequate mentoring, is disappointing. Since, at least in
theory, those with many years of employment within an academic setting should
have answered favorably to the question, “I have had adequate mentoring.”
In a similarly designed research study to mine by Paul and Stein in 2002,
309 women faculty employed full time at a graduate school of nursing indicated
mentoring occurred in 55.7% of the cases. Mentoring was related to higher work
productivity.(Paul & Stein, 2002). It should be noted that Paul and Stein solely
examined faculty members in a school of nursing a primarily female dominant
profession, where the research found that 42% of the faculty, including both men
and women, agreed that they had adequate mentorship. The idea of gender
differences and mentoring has been extensively researched in the business world
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but was not included as a separate variable in this research. In addition, the
medical faculty community has strongly supported mentoring programs especially
involving minorities and women. Gray (1998) and Wong and Bigby (2001)
highlighted the effects of mentoring women within medical school faculty
positions noting that proper mentoring resulted in lower attrition rates and
increased productivity.
In the current study, the medical faculty model was adopted from Chews
faculty mentoring research of the University of Washington in 2001. W hile Chew
provided the template for the questionnaire, it lacked the specificity which could
have provided a better correlation between adequate mentoring and number of
years as a faculty member.
The idea that new faculty members do not have adequate mentoring when
they enter academia seems plausible, additionally it should be noted that this is
also a vulnerable time for a new faculty member and they may choose to leave the
profession. The dynamics of the vulnerability of this “adjustment period” has not
been clearly defined by this research. There was no distinction of a vulnerable
period as indicated by the number of years a faculty member spent within the
institution. As I stated before, faculty members new to the environment or those
with many years in the academic setting had no difference in their response to the
first research question. If a specific vulnerable period were to be identified,
perhaps steps could be taken at this critical juncture to provide mentoring within
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95
the university setting and the idea o f leaving the profession would be significantly
lessened or perhaps even be non existent.
The data would indicate, that faculty mentoring has nothing to do with
adequate clinical practice. All nurse anesthetists are welcomed into the academic
realm, but few stay without adequate mentoring from a university. The
expectations of the clinical nurse anesthetist recruited to the academic setting is
that the job will be similar to that of clinical practice, when in fact there is a
significant and critical difference between the two settings. In our specialty, we all
try to recruit skilled clinical nurse anesthetists to the academic setting when in
reality they often turn out to be the least effective as professors. This is a fact of
some importance, especially as it applies to mentoring, since issues of retention
and keeping professors at the university is critical. Perhaps as a specialty group,
we should not look to those clinical nurse anesthetists without clear ideas of what
the academic job expectations are and providing a true mentoring program.
Learning what are the areas of importance and confidence from faculty members
is the first step in developing the best possible solution, since this has a great
impact on the university and the professors we try to recruit. O f course the
findings of this study suggest that mentoring is critically important, but we must
not lose sight of the fact that we are talking about very specific types of mentoring
that enable the transition into mentoring the academic medical profession. For
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96
exam ple, as obvious as it may seem, we need to focus our mentoring on issues
like how to teach, how to write a syllabus, etc.
Research question number 2 examined the relationship of short and long
term goals and their relationship with leaving the profession. “Is there a
significant relationship among nurse anesthesia faculty m em bers’ long and short
term goals and intention to leave the profession?”
Demographic data indicated that faculty members were about 3.5 years
younger than that of the overall age of the 30,000 nurse anesthetists within the
United States. (AANA membership data, 2003) Faculty members make up
approximately 2% of all nurse anesthetists and less than 1 % of these faculty
members hold doctoral degrees. Those who indicated they would leave the
academic setting were also higher than the national average of 20%, revealing that
those who would leave their position was 35%. Reasons for leaving varied from
retirement to returning to clinical practice. The high rate of 35% for faculty
members leaving their positions is significant for a university in need of graduate
tuition dollars. Any university should be very concerned with this high attrition
rate of their professors qualified to teach nurse anesthesia graduate studies. The
specialty of nurse anesthesia is indeed a hybrid of nursing in which not all nurses
are qualified to teach. The nurse anesthesia profession is intense and not all
nurses qualify for this nursing specialty. Given that only few nurse anesthetists
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97
qualify or desire to teach at graduate level, keeping those programs functioning is
a challenge for those universities offering these specialty graduate programs.
The reasons for leaving a nurse anesthesia academic position are in
keeping with earlier research studies of medical school and generic nursing
faculty. W hile the high attrition within this study is comparable to those in
nursing and medical programs, we should note however that with the limited
faculty pool available for nurse anesthesia education, the significance of the
attrition rate becomes magnified . Unfortunately, the expectation of actually
producing income for the university by providing patient care within the hospital
setting has overshadowed the expectations of long term academic commitment
In a review of nurse anesthesia literature, a nexus of problems was identified
which may explain the high attrition rates of nurse anesthesia faculty members
(Eckhout & Robert, 2001; Heikkila, 2002; Myers & M artin-Sheridan, 2003; Papp
& Aron, 1998). The specialty of nurse anesthesia has unique education and
practice challenges (Heikkila, 2002). Many students are unable to attend a full
time 28 month program due to financial problems. Admission criterion for entry
into a nurse anesthesia educational program is highly competitive. Not all
applicants are admitted, and not all students graduate or pass the national
certification examination. Competition for admission of only the “best and
brightest” takes nurses away from their hospital employment which adds to the
plight of shortage of nurses in general. Finally, the healthcare system’s and
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98
hospital’s concern for the bottom line has impacted nurse anesthesia in practice
and in education (Rowland & W offord, 1999; Gray, 1998). Hospitals need
clinical practitioners to provide service to patients. Hospitals are not in the
education business, but rather leave that to the universities. Nurse anesthetist
clinical practitioners clearly understand the need for competent clinical
practitioners long before graduating from their educational program. These same
nurse anesthetists also understand the high demands of hospitals and can negotiate
their own salaries in many cases. Unfortunately, these same nurse anesthetists
become the recruits for academic faculty knowing little about the university
system at large.
M entoring is crucial to decreasing attrition rates according to multiple
studies noted by Ehrich (2002).. Greene and Puetzer also noted that mentoring
decreased attrition rates of faculty members in both medical and nursing academic
programs. The significance of this to universities is compelling. According to the
2003-2004 report on Enrollment and Graduations in Baccalaureate and Graduate
Programs in Nursing conducted by the American Association of Colleges of
Nursing (AACN), 65% of the schools reported insufficient number of faculty as
the primary reason for not accepting all qualified students into entry-level
baccalaureate programs. A report released by the Southern Regional Board of
Education in 2002 stated unfilled faculty positions, resignations, projected
retirements, and the shortage of students being prepared for the faculty role all
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99
pose a threat to nursing education workforce over the next five years (Hodges &
W illiam s, 2002) An AACN survey (2000) of 220 schools reported that 5,132 full
time faculty positions were vacant. Although the vacancy rate was less than 10%,
they represent a significant hardship as even one or two vacant positions can have
a major impact on both the didactic and clinical workloads of remaining faculty.
In 2002, 5283 qualified applicants were not accepted into nursing programs and
47.5% of the schools cited a “lack of faculty” as the reason. Across the country,
the shortage of nurses is mirrored by the corresponding shortage of qualified
nursing faculty, and this problem is now reaching a critical point. Indeed, nurse
educators are aging as seen by the average age in the surveys. For example, while
the average age of full professors is 56 years, the average for associate professors
is 54 and 50 for assistant professors. (AACN, 2002)
As a specialty of nursing, nurse anesthesia faculty members are hard to recmit,
hard to find, and hard to retain. M entoring has proven itself in disciplines such as
business, nursing, and medicine. As early as 1984, Zey noted in his research that
those in business with no mentor achieved a lower status within the organization
as compared to those with mentoring. Implementing a successful mentoring
program for university faculty members based upon this research for the specialty
is a challenge.
The nurse anesthesia profession relied on the hospital status to provide
mentoring. Historically it was the “chief nurse anesthetist” who provided the
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1 0 0
guidance to the new clinical nurse anesthetist regarding the organization,
structure, and rules. The primary goal was to retain this clinical nurse anesthetist
for a long period to keep pace with the hospital healthcare demands. Only a few
of the novice clinical nurse anesthetists had any opportunity of gaining a different
status unless a clinical resigned or was otherwise released. Clinical longevity
dictated rank and status within the hospital system. To a nurse anesthetist
considering an academic position, this clinical system has been confused with the
university system.
McW eeney (2002) found that mentoring programs improved nurse
retention rates in hospitals and had similar results in academic medical centers.
Again, the environment included a hospital type of system. If we translate this
into a university setting, provide mentoring, and follow up with yearly needs
assessment, in theory, the attrition rate within nurse anesthesia academic program
should decrease. This research is the first of its kind in the specialty of nurse
anesthesia education to examine specifics of mentoring at this level of detail. The
literature review of the early 1980s indicated that there were two main reasons
faculty members left their academic position. They included return to clinical
practice, and higher financial rewards. In this research, more details regarding the
reason for leaving was explored. They include, accepting a full or part time job at
a different institution, accepting a clinical position at this or another institution,
accepting a job in another field, or retiring. Historically, clinical faculty members
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101
became academic faculty at the insistence of the program director because there
continues to be a shortage of educators in this specialty. In past research regarding
retention, the primary reason why nurse anesthetists left the academic side was to
make more money from clinical practice and have less problems with academic
responsibilities. It was those academic responsibilities the clinical nurse
anesthetist knew nothing about. In addition, university life provided little time to
keep clinical skills sharp, and practitioners had to choose.
In 2003, four new nurse anesthesia programs opened in the United States.
Universities try to recruit qualified faculty members to teach and provide
administration to these graduate programs. Under university accreditation
standards, faculty members should hold a terminal degree which in many
disciplines is a doctoral degree. Less than 1% of all nurse anesthetists hold a
doctoral degree to qualify for these new academic programs. W ith an attrition rate
of 35% and few nurse anesthetists qualifying for university academic positions,
new programs could essentially fold before they graduate their first class. W ithout
qualified faculty members those graduate programs are in jeopardy of closing and
the long term effects will show up in the hospitals when there is no anesthesia
provider to take care of the clinical needs. The highest stakeholder in nurse
anesthesia education should be both the university and the hospital. Hospitals
loose a qualified anesthesia clinician and universities loose a graduate program.
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1 0 2
In this research, only 11.7% or 7 respondents noted they would leave for a clinical
position. In addition, only 23.3% noted that their reason for leaving their current
position was to go to a different institution. Perhaps the institutions should
examine their own offerings for faculty members in the nurse anesthesia specialty
and provide mentoring to retain qualified faculty members for the long term.
Almost 82% noted they would not leave for a clinical position within the next 3
years. This could indicate that many of the faculty members were satisfied in their
academic role, but not necessarily satisfied with their specific institution. Indeed,
differences with an academic institution could make the difference for long term
employment. Additional research regarding size of academic institution or even
size of anesthesia program could effect the overall satisfaction and retention of
nurse anesthesia faculty members. Pinpointing whether current university
mentoring activities for faculty could actually promote long term commitment is
difficult given the differences in universities as well as nurse anesthesia programs.
Approximately 50% of the nurse anesthesia educational programs are housed in
schools of nursing, and the other half are in schools of medicine or allied health.
Program philosophy, curriculum, and overall mission may influence the mentoring
of both new and old faculty members.
This research did not examine a timeframe of more than 3 years for short
term goals. Question number 2 indicated, more than 88% of the faculty members
would be leaving their position for retirement within 3 years. This figure is
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staggering where the goal is to retain faculty and enable them to mentor others
while sustaining the academic program. This research showed that the age of
faculty members in nurse anesthetist programs is significantly younger compare to
the national average, thus it would be interesting to examine if the retirement age
is comparatively young as well. If 88% of the faculty members are leaving for
retirement at the average age of 50, more specific data regarding retirement should
be obtained for future research. For example, are retirees then going to work in a
different field, go back to part-time clinical work, or even work as a consultant to
other academic nurse anesthesia programs? These questions regarding retirement
could be an entirely new area of research. One very crucial finding in answer to
this research question is 91.7% (55) indicated they would not leave their current
position for another field. Generally, nurse anesthetists enjoy their chosen
specialty and the majority of nurse anesthetists continue to work within their
specialty for the long term. The literature supports this high retention rate within
the profession. The overall professional choice was positive, where few would
actually change careers once entering the nurse anesthesia specialty. Unlike
clinical nurse anesthetists, those within this study indicate they worked full time
for the university. In comparing this to the national data regarding nurse
anesthesia employment, more than 30 % of the practicing nurse anesthetists work
less than 40 hours per week (AANA W orkforce data, 2003) It is not unusual to
find professors working in excess of 60 hours per week to fulfill their academic
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104
obligations.
This sample of faculty members indicate that they identify getting a
doctoral degree as a short or long term goal. Mandates from the Council on
Accreditation for Nurse Anesthesia Educational Programs in 2002 stated that all
Program Directors m ust have a doctoral degree by 2014. (COA Standards, 2002)
This may have been the stimulus for faculty members and Program Directors to
seek enrollment in doctoral programs. The COA Standards have recently dropped
this mandate in 2004 given the high rate of faculty members retiring over the next
3-5 years. A long-term study could be conducted on the attrition of these specific
doctoral students and whether they will complete their doctoral degrees given the
changes by the COA.
Research question 3 asked, “Is there a significant relationship between the
importance and confidence of academic faculty members in areas including
scholarly work, direct patient care, supervising/teaching and administration and
the attrition rates in nurse anesthesia educational programs?”
This research question was broken down into many parts to answer the
importance/confidence relationship of academic faculty members in areas
including scholarly work, direct patient care, supervising/teaching and
administration and the attrition rates in nurse anesthesia educational programs.
Top level of importance, as indicated by a 50% response, were revealed in areas
closely related to university employment activities.
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Scholarly activities are not typically found in the in nurse anesthesia
educational programs. Many students do not use these academic skills necessary
for later employment as an anesthesia faculty member. Again, the focus for the
m aster’s programs in nurse anesthesia are clinical in nature. Skills such as using
statistical packages, writing grants, and examining data analyses are of high
importance for university faculty members, as indicated by this research.
Acquiring these skills for a position in an academic setting could be included in a
mentoring program held by the university. This research highlighted areas of
importance to the faculty member of this anesthesia specialty. Putting this
information into a workable mentoring program should be of interest to university
administrations
There was a significant relationship between the importance and
confidence in scholarly work. This research indicated that faculty members felt a
high level of importance in scholarly work but had low confidence in this area.
Scholarly work included research, publications, using statistical packages, and
grant writing. The significance in this outcome provides a starting point for
developing a mentoring program for nurse anesthesia faculty members focusing
on these areas where confidence is low. Another significant area where the
importance was high, yet the confidence was low was administration.
Administrative activities include budget management, hiring personnel,
and writing reports. Again, these activities may be an employment expectation for
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106
the academic faculty member; however, a clinical practitioner moving to an
academic setting will struggle and possibly leave. Mastering a budget has little to
do with clinical care of an elderly patient. The significance of this question is in
exam ining which areas the faculty member believes is important and also
elucidate areas where confidence is low. A faculty member may think something
is very important but have no resources to build up confidence in that specific
skill. The overall impact for universities is the loss of another nurse anesthesia
faculty member. In addition, less faculty members within the specialty limit the
number of students allowed to enter the program.
University administration should take into consideration the needs of these
specialized educators and provide mentoring opportunities. A concerted effort to
provide mentoring on university activities is critical for retention. W ithout
adequate specialized faculty for a nurse anesthesia program, the program will
close. Loss of a graduate program for lack of mentoring will decrease the
university’s overall tuition income and in many cases affect other academic
programs. The seriousness of loss of income because a faculty mentoring program
is not available should be a concern for all university administrators.
Implementing a mentoring program which is useful, applicable, and feasible for
nurse anesthesia faculty members should be a priority for universities offering
nurse anesthesia specialty programs. Universities should take serious actions to
ensure mentoring activities in those areas identified as scholarly in nature. Nurse
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107
anesthesia faculty familiar with scholarly activities could benefit from mentoring
newcomers into the academic setting.
Another variable that is integral to the importance/confidence aspect of the
research question is the demographic data that indicates the highest degree held by
the respondent. The idea of a more educated individual having more confidence in
scholarly activities holds true for many disciplines but did not have significance in
this research. Indeed faculty members may indicate high levels of importance in
areas of scholarly activities, but also reveal that they have much less confidence in
those areas. This research would suggest, that high levels of importance with
lower levels of confidence could certainly indicate a starting point for academic
mentoring. More than 63% of the respondents indicated they held a M aster’s
degree as their highest degree. Academic programs offering a m aster’s degree in
nurse anesthesia focus upon activities of delivery of safe clinical anesthesia care to
all patients within a hospital setting. W riting a m aster’s thesis may or may not be
included in these program curriculums. A student graduating from a nurse
anesthesia program may or may not have had experience with these specific
scholarly skills. Recruitment of these nurse anesthetists into the academic arena
can be a disaster for any nurse anesthesia educational program. Developing
mentoring programs dedicated to research activities could help enable these
faculty members for long term commitment. Paul and Stein (2002) support early
mentoring by developing research teams. Research teams are commonly seen at
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108
the doctoral level where research, statistical analysis, and academic activities
mandate such. These same activities are rarely seen in a clinically focused or
professional degree graduate program. This research noted that the academic
activities were highly desirable, had low confidence level, and were thought of as
important. Again, these activities mandated for a doctoral degree are missing in
more than 60% of the faculty surveyed perhaps due to the level of education of
most surveyed as M aster’s prepared. These target activities may be the beginnings
for a well planned mentoring program for those with only a M aster’s Degrees.
W hile there is a missing piece for those with only a M aster’s Degrees, additional
information regarding short and long term career goals indicated that completion
of a doctoral degree was important. In fact, almost 30% (19) indicated they
desired completion of their doctoral degree within 2-3 years. Seventeen faculty
members indicated they wanted to complete their doctoral degree within 5-10
years. The influences from the COA in 2003 mandating all program directors
have a doctoral degree by 2014 may have stimulated the surge of faculty members
entering doctoral programs over the past 5 years. It would be worth studying how
many of these doctoral students complete their respective programs given the
notification that the COA has lifted this mandate for program directors in 2004.
Research question four further investigates the relationship of a faculty
member’s actual work and time allocation. The question is “Is there a significant
relationship between the faculty m em ber’s actual, ideal, and time allocated for the
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109
activities of scholarly work, direct patient care, supervising/teaching, and
adm inistration?”
In this case, 30 faculty members indicated that they spend approximately
50% of their time in administrative activities. The other half of their actual time
spent was reportedly split between scholarly work and direct patient care. This is
the actual percentage of time and not the ideal percentage of time the respondent
would like to be doing administrative activities. Ideal time may be the perceived
hours or percentage spent in an average work week on any specific activity. For
example, ideally faculty members want to teach and balance administrative
activities equally. Teaching, patient care, and administrative duties could be seen
as 30% equal by those currently expressing they spend more than 50% of their
time with administrative activities only. W hen one specific area becomes so time
consuming to the faculty member, other areas suffer. Ideal time spent could be
defined more appropriately as equal time spent with each individual activity so not
to overburden the faculty member with only one set of tasks or expectations.
Future research in the area of ideal/actual time spent could be valuable in
providing additional information of faculty expectations as compared to university
demands.
W hereas, 70% (42) of the respondents indicated they would ideally like to
spend more time in scholarly activities, they reported less actual time in this area.
This tied together with research question number 3 where scholarly activities were
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110
noted as important with lower confidence. Logically, activities noted as low in
time spent and lower in confidence are targets for mentoring programs. Faculty
members with confidence in areas such as PowerPoint development in the
teaching area felt they spent adequate time in this area and also felt it was not as
im portant for their current academic position.
Limitations
The first limitation to this study was the survey instrument itself. The
instrument did not measure all of the constructs or variables necessary to provide
detailed answers to all of the research questions proposed. These research
questions have stimulated more detailed questions regarding mentoring, time
commitment to the four elements common to all clinical professional programs as
well as retention of current faculty members in nurse anesthesia graduate
programs.
The questionnaire was lim ited to only those faculty members within a
university setting who held specific academic appointments of assistant professor
or higher. It did not address clinical educators who may have an adjunct
affiliation with a university and only teach or have part-time administrative
commitments. It is possible that faculty members within the hospital setting face
similar mentoring issues. The literature has confused the idea of precepting with a
clinical context and true mentoring which is found at a university setting.
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Ill
The second limitation to this study involved an inherent limitation in all
survey research; faculty members may have provided socially desirable responses
or may have rushed through the questionnaires without giving much thought to
their responses. This was especially obvious within the qualitative section of this
responses.
Lastly, this research was conducted on one specialty of graduate nursing
faculty members which can only be generalized to those educators within nurse
anesthesia educational programs. There are however, many different professional
degree programs such as nurse midwifery, advanced nurse practitioners, physical
therapy, occupational therapy, and medical and dental schools who may benefit
from the outcomes of this investigation. Each program has their own graduate
specialty program which includes the clinical component and responsibilities. The
four elements of scholarly work, direct patient care, supervising/teaching and
administration are common to all professional degree programs.
Recommendations and Implications for Future Research
Faculty members within the clinical setting hold only an adjunct professor
title within an university may be the first to benefit from future research on
mentoring and academic activities. Indeed, it is this group of CRN As who are
routinely recruited to an academic appointment. Mentoring this group of clinical
practitioners may help in providing for a more successful transition from solely
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112
clinical work to that of a professor within a university setting. This research
provided a starting point for additional inquiry with perhaps more specific detailed
questions as outlined above in research questions 1 and 2. It is important to note
that not all variables were addressed such as tenure or non-tenured positions,
programs holding dual governance between a hospital and university as well as
faculty members who worked part-time. There may be benefit to investigating
these additional variables for the future.
It could be argued that nurse anesthesia educational programs are housed
in different divisions with the university setting-—such as having their own
nursing programs, or being allied with the medical school— and each has its own
internal administrative structure and mentoring strategies. It could be further
argued that not all universities are created equal in their size and offerings in their
ability to truly mentor their own faculty members. Indeed there is a split of almost
50% of the nurse anesthesia educational programs which are housed in nursing
divisions, and others are housed in schools of medicine, allied health, or other
departments or schools. (COA, 2004) Additional research could be valuable in
these separate schools to examine whether the medical model of mentoring or is
there a better nursing model of mentoring for long term career commitment of a
faculty member. The medical school and allied health divisions tend to have a
nurse anesthesia educational program with a somewhat different curriculum
design than those nurse anesthesia programs housed in schools of nursing. Basic
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113
sciences including advanced anatomy, physiology and pharmacology are the
foundational courses for many nurse anesthesia programs in allied health
divisions. Nursing theory and research are foundational courses for those
programs in schools of nursing. The National Council on Certification of Nurse
Anesthetists (CCNA) has specific mandates for academic preparedness for all
programs whether in a school of nursing or allied health. These academic
requirements include 45 hours of Professional Aspects of Nurse Anesthesia, 135
hours of Anatomy, Physiology, and Pathophysiology, 45 hours of Chemistry and
Physics, 90 hours of Pharmacology, 90 hours of Basic and Advanced Anesthesia
Practice Principles and 45 hours of clinical correlative conferences. No where in
the current curriculum are courses related to academic activities. No where in the
current curriculum standards are there courses in budgeting, personnel
management, scholarly work, or activities noted as important by faculty members
in this research. Academic programs in nurse anesthesia continue to focus on the
clinical aspects which are reflected in all of the national certification mandates.
Once a graduate successfully completes the national certification exam they are
entitled to practice anesthesia, but are poorly prepared for any academic
employment/appointment according to university standards. Developing a
mentoring program should indeed be a priority for universities with nurse
anesthesia specialty programs. As I pointed out earlier, Paul and Stein (2002)
suggested, that mentoring is best developed in teams. Natural to the nurse
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114
anesthesia educational process is the development of a team approach to patient
care involving many team players from different clinically based disciplines. An
exam ple of this is the surgeon, perhaps a cardiologist, and even a nutritionist who
would prepare the patient prior to the need for anesthesia services within the
hospital setting. Each specialist becomes a member of a collaborative team
approach to help care for the patient. Placing this idea in the context of an
academic faculty member, a team approach to mentoring could be viewed as ideal
for the new faculty member. Those nurse anesthetists interested in employment in
the academic setting could feasibly be teamed up with an educator or experienced
administrator to mentor them. One example of such a concerted effort might be to
create a mentoring team that would include a researcher/publisher, classroom
teacher, nurse anesthetist, and university administrator to guide the new employee
once they are hired. The multidiscipline approach is something the clinical nurse
anesthetist is familiar with. Each academic specialist can provide their own
expertise for the new faculty member to draw upon when the occasion arises.
Taking this context and now applying it to an academic setting may provide for a
wonderful mentoring program specific to the needs of the nurse anesthesia faculty
member. Crossing disciplines and targeting the needs of these nurse anesthesia
faculty members is the first step for a successful mentoring program.
Each educational team member has the potential to function as a mentor
within their own specialty. One could speculate that a good mentor would also
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115
provide a different focus or view to the faculty member within the university
setting. Building a team of mentors with different strengths could be the best of
both worlds. A diversity team development in a mentorship program could be
possible with continued follow up assessments and improvements.
One failing of current mentoring programs as noted in the literature along
with the AANA Foundation is the lack of follow up of the mentee by the mentor.
W hile this may initially not seem like such a problem, studies have shown that
when things are going well, mentoring activities stop. W hen the mentoring stops,
it is more difficult to trace elements which could make any transition into a new
employment situation easier. Team tracking may be the answer for this type of
dropping off of mentoring. W hen the new faculty member faces difficulties with
administrative duties of writing a budget for example, the specialist within the
team would be the appropriate person to engage and provide mentorship. If
publications were the stumbling block, the mentor for writing would be
appropriate while others would step back. The idea of having many experts help
in an ongoing mentoring process may provide the best of both worlds. No longer
would one faculty member be the sole mentor for a new hire. Each individual
academic faculty member has their own strengths and could provide the expertise
above and beyond what one sole mentor can do. How to implement a mentoring
team or program and how long the mentoring is pursued is another question for
future research. It seems logical and responsible to develop mentoring teams to
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1 1 6
collaborate with a new academician. W hether we can conclude that mentoring in
the first year of a nurse anesthesia faculty m em ber’s position is critical, or whether
it is critical at year number 7 when tenure could be awarded was not part of this
research. A new research study on tenure and non-tenure track positions for
nurse anesthesia faculty members could provide a different perspective into
longevity within the academic setting.
Throughout the generic M aster’s Degree program for nurse anesthetists,
the focus is and always has been clinical anesthesia safety and patient care. Little
attention has been paid to those who educate or hold university positions. The
great divide between the two could come closer together with actual mentoring
programs for those in the clinical area contemplating a position in the academic
world. This research has strongly purported that today’s nurse anesthesia faculty
recognize the differences and expectations of an academic or clinical setting. It is
these differences which make future research on faculty mentoring possible.
The final outcome would be longer lasting faculty members for nurse
anesthesia educational programs where specialty survivability would not be a
question.
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117
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Appendix A
FACULTY SELF-ASSESSMENT SURVEY
The purpose of this questionnaire is to learn about your academic needs with regard to your
career goals. Your input will be used to help answer several questions regarding Program
Directors and Faculty of Nurse Anesthesia Programs. Please answer the following questions to
the best of your ability. THANK YOU©!
Dem ographic^
1. Today’s date:
2. Your age:
Geographic location of program: (please circle) North South East
Midwest W est
3. Sex: Male
to
Female
( 2 )
4. Race:
Caucasian
(i)
African-American
(2)
Latino/Latina (4 ) American Indian/Native Alaskan ( 5 )
Other
< 6)
Asian
(3 )
6. Degrees (check all that apply):
M.S.
(i)
M.A.
Other (please specify).
(4 )
M.S.N.
M.H.S.
(2)
(5)
Ph.D. in .
Ed.D. in
- ( 3)
- ( 6)
- ( 7)
7. Title:
Instructor
0)
Assistant Professor
(2 )
Associate
( 3 )
Full Professor
(4 )
9. Status: Full Time
0 )
Part Time (2 ), if so, what percentage
■(3)
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128
10. N um ber of years at current rank:__________
11. N um ber of years as Faculty: __________
12. Track:
Clinician-Administrator (1 ) Clinician-Educator (2 )
Clinician-Clinician ( 3 > j
13. C heck if you have received formal post-graduate education in any of the
following areas: (check all that apply)
Clinical Trials ([)
Basic Science Research (2 )
Health Services Research (3 )
Teaching (4 )
Administration ( 5 )
i n m 1 .dim .ilioii
16. According to your best understanding, what percent of your time is to be
allocated to each of the following activities? (Must add up to 100%.)
a. Scholarlv work %
b. Direct patient care %
c. Supervising/Teaching %
d. Administration %
e Other %
100%
17. W hat percent of your time do you actually spend doing the following activities?
(Must add up to 100%.)
c. Scholarlv work %
d. Direct patient care %
c. Supervising/Teaching %
d. Administration %
e Other %
100%
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129
18. W h at percent of your time would you ideally spend doing the following
activities? (Must add up to 100%.)
e. Scholarlv work %
f. D irect patient care %
c. Supervising/Teaching %
d. Administration %
e. O ther %
100%
i Kacultx Skills Self-Assessm ent
i ______________________________ S ---------------------------------------------------------------------
Please take a minute to consider and then list your short-term career goals (those
goals that you hope to accomplish in the next 2-3 years) and your long-term
career goals (those goals that you hope to accomplish over the next 5-10 years).
19. M y short-term career goals:
a. ________________________________________________________________
b . ___________________________________________________________________________
c. ____________________________________________________________________
d . ________________________________________________________________________
20. M y long-term career goals:
a. _________________________________________________________________
b . ___________________________________________________________________________
c. ____________________________________________________________________
d . ________________________________________________________________________
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130
With your short-term and long-term goals in mind, review the list of skills
below. On a scale of zero to ten, rate the importance of each skill area based on
your career goals. Then indicate, on a scale of zero to ten, your confidence in
the personal skill areas. If you desire training in any of the particular skill
areas, mark the third column with an “x”.
Please use the following scales;
Importance: 0 = not important ..............->
Confidence: 0 = not confident ----------
SKIT/LS IMPORTANCE
TRAINING
to career goals in skill level mark with an
(0->10) (0-> 10) (“X”)
PA iILNft Wit
21. Physical diagnosis _________ ________ ________
22. M edical knowledge _________ ________ ________
23. M anagement of multiple
complex problems _________ ________ ________
24. M anagement of patients in
the inpatient care setting _________ ________ ________
25. Management of patients in
the ambulatory care setting _________ ________ ________
10 = critically important
10 = fully confident
CONFIDENCE DESIRE
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131
Please use the following scales:
Importance: 0 = not important .................... 10
Confidence: 0 = not confident ..............-> 10
SKIT J„lS IMPORTANCE
TRAINING
to career goals
(0 - » 10)
: v \ c
26. One-to-one teaching
(i.e. operating room) _________
27. Small group teaching
(i.e. clinical conferences) _________
28. Curriculum development
for nurse anesthesia
students _________
29. Providing constructive
feedback to anesthesia
students __________
30. Teaching portfolio
development __________
K < < !..' *
31. Survey instrument
design_________________ __________
32. Data analysis___________ __________
33. Grant writing___________ ___________
critically important
fully confident
CONFIDENCE DESIRE
in skill level mark with an
(0-»10) (“X ”)
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132
34. Fam iliarity with the
IRB process___________ ___________ __________ _________
35. W riting an abstract ___________ __________ _________
36. Presenting a poster
at a national conference ___________ _ _________ _________
37. W riting an original
research manuscript ___________ _________ _________
Please use the following scales;
Importance: 0 = not important — ------> 10 = critically important
Confidence: 0 = not confident ..............-> 10 = fully confident
SK IL L S IMPORTANCE CONFIDENCE DESIRE
TRAINING
to career goals in skill level mark with an
(0-» 10) (0-> 10) (“X”)
'l/.iNAf'I* SlLN i SKILL',
38. Budget management ___________ . __________ ________
39. Personnel/staff
management_______________________ __________ ________
M M M M B M M H W B M W i
40. Critical journal article
review ___________ ___________ ________
41. Internet browsing_______ ___________ ___________ ________
42. Literature searches ___________ __________ ________
43. W riting a review article ___________ __________ ________
44. W riting a book chapter ___________ __________ ________
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133
45. U sing statistical packages
(i.e. SAS, SPSS, STATA)
46. U sing reference database
softw are (i.e. Endnote)
47. Preparing presentations
w ith Power Point
48. U sing database/electronic
spread sheet programs
(i.e. Access, Excel)
Fiicultt Solf-AsKcssiniMil
■ ■ ■ L - - ........
Please circle the extent to which you agree with the following statements.
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
I am aware of the
promotion criteria.
1 2 3 4 5
I am confident I will
achieve my short-term
goals.
1 2 3 4 5
I am confident I will
achieve my long-term
goals.
1 2 3 4 5
I provide excellent patient
care.
1 2 3 4 5
I am an excellent
researcher.
1 2 3 4 5
I am an excellent teacher. 1 2 3 4 5
I am an excellent manager. 1 2 3 4 5
I manage my time well. 1 2 3 4 5
I have adequate secretarial
support.
1 2 3 4 5
I have adequate
mentorship.
1 2 3 4 5
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134
59. Do you have access to a senior faculty member in your department that you trust
and who will support you in achieving your career goals? No U ) Yes (2 )
60. If yes, do you feel that this person is your mentor? No (1 ) Yes ( 2 )
61. H ave you ever written research grant proposals?
No (1 )
Yes (2 ) How m any?_________How many were funded?___________
62. H ave you submitted a manuscript to a peer-review journal?
No (1 ) Yes (2 ) How m any?_______ How many accepted?______
63. H ave you published book chapters? No (1 ) Yes (2 ) How m any?______
64. H ave you developed curricula/syllabi for nurse anesthesia students or faculty?
No (1 ) Yes ( 2 )
65. In the next 3 years how likely is it that you will leave this job to:
1. Accept a full or part time job at a different institution
2. Accept a clinical position at this or another institution
3. Accept a job in another field
4. Retire
THANK YOU ©!
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135
Appendix B
Survey C over Letter
Name/Address of Recipient
Y our participation in a research project is requested. This research is being
conducted by Linda Serra Hagedorn, PhD Associate Professor of Education and
Dolores A. Maxey, MS CRNA a doctoral candidate in the Rossier School of
Education at the University of Southern California in Los Angeles, California.
Findings from this survey will be used in my dissertation. The aim of this research
entitled” Mentoring Faculty in Nurse Anesthesia Educational Program s” is to
explore areas of faculty mentoring and development within your own program. The
enclosed survey will assess these areas. W e anticipate approximately 100
participants in this study.
If you decide to participate in this research please complete the enclosed
survey. This should take no more than 15-30 minutes to complete. Please return it in
the pre-addressed postage paid envelope to the researcher. Your consent to
participate in this research is strictly voluntary and should you decline to participate,
there will be no adverse effects of any kind. In addition, while there are no direct
benefits to you, your participation in this study will greatly help our understanding
of mentoring needs of faculty and program directors within nurse anesthesia
educational programs throughout the United States.
As a research participant, information you provide will remain anonymous,
that is no names or other identifiers will be collected on the instrument used. Data
will be kept in a locked file in the researcher’s office until the study analysis is
complete. Once the analysis is complete, the data will be shredded.
I would like to thank you for taking time from your busy schedule to
complete this survey and assist us with this research. Your participation is greatly
appreciated.
Sincerely,
Dolores A. Maxey, MS CRNA
Doctoral Candidate
Rossier School of Education
University of Southern California
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Asset Metadata
Creator
Maxey-Gibbs, Dolores Ann
(author)
Core Title
Faculty mentoring in nurse anesthesia educational programs
School
Graduate School
Degree
Doctor of Philosophy
Degree Program
Education
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
education, administration,Health Sciences, Education,health sciences, nursing,OAI-PMH Harvest
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Hagedorn, Linda Serra (
committee chair
), Sundt, Melora (
committee member
), Waugaman, Wynne (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c16-348040
Unique identifier
UC11340270
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3180390.pdf (filename),usctheses-c16-348040 (legacy record id)
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3180390.pdf
Dmrecord
348040
Document Type
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Maxey-Gibbs, Dolores Ann
Type
texts
Source
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(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...
Repository Name
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Repository Location
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Tags
education, administration
Health Sciences, Education
health sciences, nursing