International Journal of Nursing Education Scholarship

Volume 4, Issue 1 2007 Article 6

Practicing What We Preach: Balancing Teaching and Clinical Practice Competencies

Maureen A. Little P. Jane Milliken

Selkirk College, mlittle@selkirk.ca University of Victoria, jmillike@uvic.ca

Copyright c 2007 The Berkeley Electronic Press. All rights reserved.

Practicing What We Preach: Balancing Teaching and Clinical Practice Competencies

Maureen A. Little and P. Jane Milliken

Abstract
Most nurse educators fulll dual roles of clinical practitioner and teacher and thus have to achieve a balance between these two challenging sets of competencies. The authors discuss the obligation and expectation that nurse educators are concurrently experts in clinical practice and education. Is this dual competence a feasible and sustainable goal? To begin to explore this issue, the meanings of expert practice and practice competence, derived from the nursing education literature, are reviewed. Current professional practice competency requirements related to the nurse educator role are discussed. Questions are raised regarding support for and barriers to achieving these competencies. The potential challenges and rewards of this endeavour are presented and illustrated by two nurse educators who share their stories of achieving a balance in teaching and clinical practice competence. Finally, implications for nurse educators and directions for future research into this issue are proposed. KEYWORDS: nursing, practice, faculty, competence

Little and Milliken: Balancing Teaching and Clinical Practice Competencies

Most nurse educators are expected to fulfill dual roles of clinical practitioner and teacher, and thus have at least two challenging sets of competencies to acquire. In this paper, we discuss the obligation and expectation that nurse educators are experts in clinical practice and education concurrently. Is the expected high level of clinical practice competence a feasible and sustainable goal in todays increasingly complex health care system? On the one hand, this question becomes one of safety in the client setting when academically-oriented nurse educators find themselves mismatched with the clinical learning context or unprepared to cope with the acuity of the care demands. On the other hand, the increasing shortage of faculty has also increased the proportion of sessional to full-time clinical practice instructors. More often than previously, clinical instructor positions are short-term, part-time appointments, filled by nurses hired for their clinical experience, rather than teaching expertise. These sessional faculty members often do not teach in the classroom setting and thus are not likely to be familiar with the theoretical underpinnings of the curriculum. Conversely, tenured or regularized instructors are primarily in the classroom, teaching the theoretical components of the curriculum. They may have fewer opportunities to hone and update their clinical knowledge and skill to keep pace with inevitable changes in the health care setting. Although periodic updating of clinical skills and knowledge may appear to be a logical solution for theoretically-oriented teachers (Love, 1996), the lack of available time and resources (Steele, 1990), or fear of being incompetent (Budden, 1994) may preclude this. Further, feeling unprepared, especially in basic life sciences knowledge, may lead some academics to avoid clinical teaching altogether (Akinsanya, 1986; Love, 1996). For an academic nurse educator who does contemplate a return to clinical practice, Steele (1990) provides the following advice: Expect culture shock, identify orientation needs, find a resource person, learn the institutions formal routine, and assess and use the institutions informal network (p. 39). Similarly, Duldt observed that the return to clinical practice after being away for an extended period of time, regardless of ones previous practice competence, can be a shocking experience (Barnes, Duldt, & Green, 1994). Protected time for updating (possibly a sabbatical leave) is recommended, rather than attempting to learn while simultaneously engaged in clinical teaching (Love, 1996). When faced with the realities of teaching novice students who require accurate direction and modeling to apply their theoretical learning and to develop their clinical practice safely, the nurse educator faces serious professional and ethical challenges.

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EXPERT PRACTICE AND PRACTICE COMPETENCE FOR NURSE EDUCATORS The work of Patricia Benner immediately comes to mind when one is contemplating expert nursing practice. Benner applied the Dreyfus (as cited in Benner, 1984) model of skills acquisition and development to delineate 5 stages of development in nursing practice: (a) novice, (b) advanced beginner, (c) competent, (d) proficient, and (e) expert. According to Benners description of each stage, there is a substantial difference in practice ability and experience between a competent and an expert practitioner. The competent practitioner has 23 years of experience in the same or similar setting; engages in conscious and deliberate planning; and consistently uses an analytic framework. The expert has practiced for 6 or more years in the same or similar setting and does not rely on maxims, rules, or analytic frameworks. In this conceptualization, it would be very difficult for nurses concurrently to gain experience and knowledge, and develop skills, in the education and clinical settings to achieve dual expertise. The characteristics of the competent practitioner described by Benner (1984) i.e., years of experience and modes of planning care, seem more in line with the qualifications of sessional clinical instructors than classroom faculty. We propose, therefore, that the term competence is more accurate and achievable than expert when describing the clinical practice requirements for a full-time faculty member. Because nursing is a practice-based profession, there has existed a widespread assumption that those who teach nursing are also competent clinical practitioners (Fawcett & McQueen, 1994). Conversely, there is an unsubstantiated assumption that if one is an expert in clinical practice, one will naturally be successful in transmitting that knowledge to novices (Zungolo, 2004). Clinical competence and teaching skills are consistently identified by researchers as two of the major characteristics of clinical teachers (Murphy, 2000; Nahas, Nour, & AlNobani, 1999). The definition of teaching competence has evolved in the nursing literature as its importance to excellence in nursing education became realized (Gelmon, 1999). In a Norwegian study, nurse educators rated the importance of teaching and nursing competencies more highly than other aspects of teaching nursing, such as evaluation skills, establishing teacher-student relationships, and the instructors personality (Johnsen, Aasgaard, Wahl, & Salminen, 2002). Worldwide, nursing students identify clinical competence as being an important quality of effective teachers (Nahas et al., 1999; Tang, Chou, & Chiang, 2005).

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Little and Milliken: Balancing Teaching and Clinical Practice Competencies

Many nurse educators attain their first teaching job because of their clinical knowledge and skills, with the expectation that these qualities make them good role models for students (Choudhry, 1992; Zungolo, 2004). The ability to enliven the discussion of theoretical concepts by illustrating them with real stories of patients and situations that reflect current clinical experience can change what students may interpret as ideology into lasting impressions (Duffy-Durnin, 2004; Kubecka, 2004). CURRENT PROFESSIONAL PRACTICE COMPETENCE REQUIREMENTS RELATED TO THE NURSE EDUCATOR ROLE Professional standards for nursing are defined by the regulating body of the jurisdiction within which a nurse is working and registered. Thus, as nursing faculty members in British Columbia, Canada, we accessed relevant documents to help us understand more fully our competency requirements as nurse educators. The College of Registered Nurses of British Columbia (CRNBC) sets the professional standards for registered nurses in clinical practice, education, administration, and research. The indicators under each of the six standards are nearly identical for the clinical practice and education dimensions of nursing, with the exception of the focus on client outcomes for the practitioner and educational outcomes for the educator (CRNBC, 2005a). This Standards document supports the suggestion that nurse educators do have dual and equivalent responsibility for clinical practice and education competence. A definition of the practice of nursing is provided by the CRNBC (2006a). However, the exact determination of what constitutes competent clinical practice for nurses who are educators is somewhat elusive, as the definition is intentionally broad. The definition is linked specifically to nurse educators in another document that outlines the scope of practice for registered nurses (CRNBC, 2006b). Furthermore, certain criteria are expected to be met before any nurses activities may be called the practice of nursing, including the consistent application of registered nursing competencies (CRNBC, 2006a). The expectation of ongoing competence is operationalized through the Continuing Competency program, whereby nurses are required to work a minimum number of practice hours over a 5-year period and conduct an annual personal practice review (CRNBC, 2005b). Practice hours are not clearly defined and a nurse educator teaching for 1700 hours each year meets this aspect of the practice requirements for registration, regardless of the context in which the education took place. In the personal practice review, nurses self-assess by comparing their achievement to the professional standards, reviewing the

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assessment with a peer, and developing a plan to acquire and evaluate identified gaps in competence (CRNBC, 2005b). Monitoring of this process is on a random basis and essentially nurses are on their own recognizance for carrying out this program. The CRNBC (2005c) Education Program Recognition (EPR) process could potentially provide another opportunity for the professional body to monitor progress towards meeting expectations for faculty clinical practice competence. As one part of the process, nursing programs are required to submit, for review and approval, information about the curriculum, including classroom, library, and faculty resources (CRNBC, 2005c). According to the guidelines for describing faculty, information must be provided about faculty qualifications, numbers, and their availability to students and preceptors (CRNBC, 2005c, p. 9). There is no other request for information about faculty teaching or clinical practice competence anywhere in the EPR process document. Although voluntary for nursing programs in British Columbia, most seek accreditation from the Canadian Association of Schools of Nursing (CASN). Similar to the CRNBC EPR process, the CASN accreditation information describes nursing faculty as one of the resources that enable the educational unit to deliver quality nursing education and support scholarship (CASN, 2006). Further, a separate standard for accreditation is devoted to scholarship. The definition of scholarship used in the review process is multidimensional and includes elements of teaching (in classroom or clinical settings), application (of theory to practice), service (to the profession), discovery (pursuing research), and integration (contributing to interdisciplinary efforts) (CASN, 2006). The accreditation process potentially provides the opportunity to identify strengths and deficits of the collective facultys competence in these areas of scholarship. Nevertheless, specific expectations for individual faculty clinical competence are not delineated as a focus of the accreditation review. Finally, we looked at how American nursing colleagues are defining practice competence for academic nurse educators. It was thought that a recent and widely distributed document might offer a potential model for identifying evidence of nurse educators competence. In the Core Competencies of Nurse Educators with Task Statements (National League for Nursing [NLN] 2005a), seven competencies with related task statements are described. These competencies are: (a) facilitate learning; (b) facilitate learning development and socialization; (c) use assessment and evaluation strategies; (d) participate in curriculum design and evaluation of program outcomes; (e) function as a change agent and leader; (f) pursue continuous quality improvement in the nurse educator

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Little and Milliken: Balancing Teaching and Clinical Practice Competencies

role; and (g) engage in scholarship. Two of these competencies identify and describe aspects of the nurse educators role in relation to nursing practice competence. The first, facilitate learning, includes a descriptor directing nurse educators to maintain the professional practice knowledge base needed to help learners prepare for contemporary nursing practice (NLN, 2005a, p.1). The sixth, pursue continuous quality improvement in the nurse educator role, requires nurse educators to recognize that their role is multidimensional and that an ongoing commitment to develop and maintain competence in the role is essential (NLN, 2005a, p. 6). This can be achieved by balancing the teaching, scholarship, and service demands inherent in the role of educator and member of an academic institution (NLN, 2005a, p. 6). Thus, the NLN competencies further support the dual obligations for competence as teachers and clinical practitioners. In the documents identified above, there is evidence that professional associations in Canada and the United States of America are making strides in defining the full range of competencies required of nurse educators. Yet, the process of monitoring and measuring competence is not well established. Although a great deal of the responsibility rests with individual nurse educators, efforts are now underway to develop effective models for developing and validating emerging nurse educator competencies (Davis, Stullenbarger, Dearman, & Kelley, 2005; Good & Schubert, 2001; NLN, 2004, 2005b). BALANCING THE DUAL COMPETENCIES: BARRIERS AND SUPPORT Maintaining currency in clinical nursing practice itself is challenging, given the rate of knowledge development and technological change, even without the competing demands of attaining and sustaining an academic position (Weitzel, 1996). Increasingly, nurse educators are required to have masters or doctoral level preparation, which few are able to attain without leaving the clinical practice setting for several years (Mason, 2003). Once in a full-time faculty position, it becomes less and less realistic for a faculty member to return to active clinical practice. With the focus of current masters-level studies on clinical specialization rather than nursing education, many new faculty members are not academically prepared for the challenges posed by teaching in evolving nursing curricula (Zungolo, 2004). Constant pressure to expand ones teaching abilities and scope, learn the intricacies of educational administration and, in some settings, develop a research program, reduces the time and energy available (Fitzpatrick, 2002). Even without adding clinical practice to the mix, the workload is heavy and often very stressful (Budden, 1994).

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Is acquisition of these dual sets of competencies feasible and, if so, how can they be sustained in the dynamic praxis of heath care? How realistic is it to expect nurse educators to balance clinical practice competence, along with a high level of teaching competence? What are the consequences of being more teacher than clinical practitioner (or more practitioner than teacher)? To respond to these questions, a number of personal, institutional, and health care system-related factors must be considered. Each nurse educator is responsible for determining how to achieve the competencies prescribed by the professional association for educators. The value placed on epistemology and praxis is individually determined and the balance between the dual sets of competencies might be weighted differently, according to individual perceptions of the definition of practice. Some nurse educators hold firm the beliefs that teaching is nursing practice and that the academic grasp of the subject matter is the essential component for teacher effectiveness, thus enabling one to explain the theory clearly so that students can understand (Tanner, 1997). Nurses teaching from this paradigm would not place an equal value on maintaining hands-on clinical practice competencies; they would argue that they are practicing nursing every time they teach, regardless of the setting. In clinical settings, these educators often rely on establishing a partnership with clinical nurses, as preceptors or co-teachers, to provide the best learning for students (Barnes, Duldt, & Green, 1994; Murphy, 2000; Myrick & Yonge, 2005). Other nurse educators enact their role by focusing on clinical practice competence, and minimize their development of competencies related to pedagogy. These nurse educators may not view teaching as a distinct practice in itself, one that requires the same rigorous attention to standards as being involved in direct client care (Tanner, 1997). Ideally, nurse educators would be interested in maintaining both teaching and clinical practice abilities, and would be supported to do so. However, there may be institutional barriers to this balance. As noted before, there is an increasing trend to have short-term, part-time instructors who are competent practitioners, but novice educators, in clinical settings with nursing students. Due to the shortage of nursing faculty, nursing program administrators may even feel pressured to hire sessional clinical instructors with relatively limited clinical practice experience and no teaching experience. The resulting isolation of the clinical learning experience from the classroom theoretical components of the curriculum may expand the theory-practice gap. For tenure-track or tenured nursing faculty, there are institutional pressures that may cause educators to focus their attention and energy on

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Little and Milliken: Balancing Teaching and Clinical Practice Competencies

furthering academic competencies in research and other scholarly undertakings, rather than clinical practice competencies. Although there is a growing movement to value modes of scholarship other than formal research, such as teaching, there is still a prevailing publish or perish mindset at many educational institutions (Broussard, Delahoussaye, & Poirrier, 1996; Kraft, 1998). Again, the isolation from clinical practice that these academia-focused educators may experience diminishes praxis and could further perpetuate the theory-practice gap. For any nurse educator attempting to balance teaching and clinical practice, the changing healthcare system makes the acquisition of competence a rapidly moving target. Therefore, dual competence requires a sustained commitment to stay current in the clinical practice areas where the faculty member is supervising students. On a promising note, however, new models linking educators with clinical practitioners are emerging. For example, joint appointments (Beitz & Heinzer, 2000) and other recent innovations encouraging collaborative practice and education opportunities among nursing faculty and clinical practitioners are being developed and evaluated (Evans & Lang, 2004; Good & Schubert, 2001; Hunsberger, Baumann, Lappan, Carter, Bowman, & Goddard, 2000; Miller, Bleich, Hathaway, & Warren, 2004; Murphy, 2000). FINDING THE BALANCE: TWO STORIES Maureens Story I have been a nurse educator for 23 years. Previously, I practiced nursing in pediatric intensive care, adult acute care, and family-oriented community health care, all in the large Canadian cities of Vancouver and Toronto. In 1985, I left Toronto and joined the nursing faculty at Selkirk College in the rural West Kootenay region of British Columbia. In my first semester, I was assigned to the small community hospital in Trail, with 8 second-year students, on 5 different units (Medical, Surgical, Maternity, Pediatrics, and Psychiatry). I had previous experience as a sessional nurse educator in Vancouver and Toronto, but there I had been assigned to a single unit with one group of students in a familiar area of practice. How was I going to fill in the gaps in my clinical practice knowledge and skills in acute inpatient psychiatric and maternity nursing? I dedicated several weeks before starting the first year, and then each subsequent year during professional development time, to work in all the clinical practice areas where I would teach students. I eventually felt that I was honestly saying, I know this. rather than I think I know. This was a challenge but very worthwhile. I felt competent in both teaching and clinical practice. Feedback from students and staff seemed to indicate that I was contributing to the education process in an effective

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manner. Then I assumed an administrative position for 4 years between 1996 and 2000. I was not in the clinical practice area with students during that time. When my administrative term was nearing its end, I thought about how to prepare for returning to practice with students. I had been working towards a deferred salary leave for 2000-2001 and decided to use this time to re-tool myself. I enrolled in a recognized RN refresher program and started the first course in the fall of 2000. The program was intensive, and yet my general familiarity with the content was gratifying. I completed the program in May of 2001, ending with a 2-month medical-surgical and maternity preceptorship in the acute care hospital where I would be resuming instruction with students. The experience of being a student again raised complex questions for me about nursing education and clinical practice. I had a long, critical look over the edge of the theory-practice gap and saw where and why some places were better for bridge-building than others. Most satisfying was the chance to really nurse again and discover that I still had a passion for providing quality client care. My respect for nurses in clinical practice grew tremendously and they also expressed their appreciation of my efforts to truly understand their challenges. At the completion of the refresher program, I viewed my return to competent classroom and clinical practice teaching as achievable. Now, several years later, I still value the experience of that year and call on it often when Im working with third-year students on the units and to bring reality to the theory in the classroom. I remain very aware that my current level of clinical competence is tenuous and is limited to selected contexts of practice. For example, without further extensive effort, I would not be adequately prepared to take students into a critical care setting or specialty area of practice in an urban setting. My clinical practice competence requires regular maintenance and I try to accomplish this through self-directed mini-refresher sessions in the practice setting during noninstructional, professional development semesters. I look forward to these times to refuel for my next journey with students in the clinical and classroom settings. Janes Story In Edmonton in 1971, I left a general surgery staff nurse position to work for a visiting nurse agency and, aside from 18 months of part-time secondment to a rehabilitation hospital in a public health liaison role, have not worked in a hospital since. Over many years, I was a stay-at-home parent, community volunteer, student, and eventually, a nurse educator. Five years ago, I found

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myself instructing third- and fourth-year students in preceptored practica in acute care. I gave up my nursing registration while at home. After eleven years, I was faced with deciding whether I still wanted to be a nurse when I grew up. The university beckoned and I found a second calling in sociology. Not surprisingly, I was drawn to courses in aging, health and illness, and health care organization. While writing my thesis, I simultaneously completed a nursing refresher course, with an associated practicum in public health. I hoped I could find a way to combine my two passions, nursing and sociology. Halfway through doctoral studies in sociology, I moved to Victoria where I was hired to teach a data analysis course to students in nursing, social work, and child and youth care. Soon, I taught other nursing courses, and with the completion of my doctorate came a tenure-track position. Then I was asked to teach a practice course. I loved the first one, with students placed in community agencies. Later, I panicked when assigned students in acute care preceptorships with each student on a different unit. According to the course coordinator, You dont need to be an expert in clinical practice. Your job is communication: meeting with and supporting the students and their preceptors, and gathering information for evaluation. I was anxious, but armed with a pocket drug book and therapeutics manual, I found I could probe students to reflect critically on their nursing knowledge and practice and, along the way, I learned so much from them. Still, it wasnt enough. For my own satisfaction, I needed to regain a degree of clinical competence. With a sabbatical due in 2004-05, I applied for a study leave directed at strengthening my clinical knowledge and experience, and thus, I argued, my teaching and my developing research focus on mental health issues. University approval was only one hurdle I had to overcome. I wanted to begin with an advanced pathophysiology course by distance from another Canadian university and needed to convince that university to accept me into its nurse practitioner program, but to complete only this course. Next, my request to the local health authority for practicum opportunities meant renegotiating the legal agreement between the university and the health authority. The agreement covered university faculty as teachers on hospital units and university students as learners on hospital units, but not faculty members (already RNs) as learners (not employees) within the hospital setting. Eventually, with that process completed, I was permitted to participate as a non-employee in the orientation for newly-hired RNs in December 2004, after which I worked alongside students on a general psychiatry unit for the month of January. For five, 12-hour shifts in April, I shadowed nurses at a smaller

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hospital in medicine, surgery, palliative care, and emergency. Between these two experiences, I spent an exciting mid-winter month at an outpost health center in Wha Ti, a community of 450 people 170 kilometers northwest of Yellowknife, North West Territories. There, I followed and observed two very skilled nurses, one a former undergraduate student of mine. It was a year of learning, renewal, and inspiration, but also a humbling experience with constant reminders of how much I still do not know and cannot do. Nevertheless, I have gained in clinical currency and competence. In the classroom, I can enliven discussion and illustrate theoretical concepts with my new stories. I remain thankful, however, that when teaching students in acute care practice settings, I am able to collaborate with experienced nurses to teach the nuances of their context-specific knowledge and skills. PROPOSED DIRECTIONS FOR FUTURE RESEARCH Many more questions than answers have arisen in our exploration of nurse educators dual competencies. However, summarized below in the Table, we emphasize several qualities of clinical practice competence and their implications for nurse educators. These qualities may stimulate further research. In the quest for more specific findings, this discussion points us in many directions, several of which are highlighted here. We wonder about the evaluation of nurse educators with respect to teaching and clinical practice competence. How are nursing programs evaluating the competence of their faculty? Are they using these data to place faculty in suitable clinical settings according to their level of competence? To facilitate this inquiry, we suggest an exploration of how faculty members define and ultimately gather evidence of their clinical practice competence, with data gathered through academic or professional associations. While faculty members may be struggling with the challenge of balancing clinical practice and academic competence, what are the perceptions of the students accompanying them in the clinical area? What level of clinical competence are students expecting now that baccalaureate level competencies are the requirement for nurse registration in most of Canada? Canadian research efforts could be directed towards a continuation of the studies conducted elsewhere on students perceptions of faculty clinical competence, but tailored to the current state of nursing education and health care in Canada to contribute to our understanding of the national relevance of this issue.

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Little and Milliken: Balancing Teaching and Clinical Practice Competencies

Table Qualities of Clinical Practice Competence and Implications for Nurse Educators
Quality Essential Elusive Implications To meet professional requirements and to practice safely, nurse educators must maintain their clinical practice competence. Clinical practice competence for nurse educators is hard to define clearly or to measure. It is self-determined as well as prescribed by others; it is a value-laden concept. It is in the eye of the beholder. Constant changes in all clinical nursing practice settings make the required competencies a moving target. Competence in one setting is not necessarily transferable to others. Competence in any education setting is a time-limited acquisition and needs to be nourished to be sustained. It takes time, money, and effort to maintain all forms of practice competence. Personal and professional satisfaction is the reward gained from achieving practice competence.

Situational

Temporary Demanding Rewarding

What are the perceptions of practicing nurses and other staff members about the competence of nursing faculty who bring students into their context of clinical practice? What level of competence do they expect of a clinical instructor and how do they recommend it be achieved? An investigation such as this would be beneficial in opening dialogue regarding the theory-practice gap, building some bridges of understanding among educators and clinical practitioners, and opening new possibilities for collaboration in educating students. CONCLUSION This discussion has cast some light on the nature of the balance required in the teaching and clinical practice competencies of nurse educators, while revealing the complexity of the issue. There is an urgent need for more to be known about dual competencies in nursing education, from the perspectives of educators, teaching institutions, professional associations, clinical facilities, and
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students. Ultimately, the public is better served when those teaching our next generation of practitioners have the skills and knowledge to model relevant and competent clinical nursing practice. Nurse educators who are able to practice what they preach are regarded as credible leaders, inspirational mentors, and understanding colleagues. We challenge our academic and clinical practice colleagues to consider this issue and participate in the dialogue for change. REFERENCES Akinsanya, J. (1986). Nursing education and the life sciences: Poorly prepared. Senior Nurse, 4(6), 32-33. Barnes, N. I., Duldt, B. W., & Green, P. L. (1994). Perspectives of faculty practice & clinical competence: A trilogy of paradox. Nurse Educator, 19(3), 13-17. Beitz, J. M. & Heinzer, M. M. (2000). Faculty practice in joint appointments: Implications for nursing staff development. The Journal of Continuing Education in Nursing, 31(5), 232-236. Benner, P. (1984). From novice to expert. Menlo Park, CA: Addison-Wesley. Budden, L. (1994). Nursing faculty practice: Benefits & costs. Journal of Advanced Nursing, 19, 1241-1246. Broussard, A. B., Delahoussaye, C. P., & Poirrier, G. P. (1996). The practice role in the academic nursing community. Journal of Nursing Education, 35(2), 82-87. Canadian Association of Schools of Nursing. (2006). CASN accreditation program retrieved February 2, 2007 from http://www.casn.ca/content.php?doc=6 Choudhry, U. K. (1992). Faculty practice competencies: Nurse educators perceptions. Canadian Journal of Nursing Research, 24(3), 5-17. College of Registered Nurses of British Columbia. (2005a). Professional standards for registered nurses and nurse practitioners. Vancouver, BC: Author. College of Registered Nurses of British Columbia. (2005b). Continuing competence requirements for renewal of practicing registration: Fact sheet. Vancouver, BC: Author. College of Registered Nurses of British Columbia. (2005c). Education program review policy document. Vancouver, BC: Author. College of Registered Nurses of British Columbia. (2006a). Practice of nursing: Fact sheet. Vancouver, BC: Author.

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College of Registered Nurses of British Columbia. (2006b). Scope of practice for registered nurses: standards, limits, and conditions. Vancouver, BC: Author. Davis, D., Stullenbarger, E., Dearman, C., & Kelley, J. A. (2005). Proposed nurse educator competencies: Development and validation of a model. Nursing Outlook, 53, 206-211. Duffy-Durnin, K. (2004). Letters: From baccalaureate to the doctorate. American Journal of Nursing, 104(2), 15. Evans, L. K. & Lang, N. M. (2004). Academic nursing practice: Helping to shape the future of health care. New York: Springer. Fawcett, T. N. & McQueen, A. (1994). Clinical credibility and the role of the nurse teacher. Nurse Education Today, 14, 264-271. Fitzpatrick, J.F. (2002). The balance in nursing: Clinical and scientific ways of knowing and being. Nursing Education Perspectives, 23(2), 57. Gelmon, S. B. (1999). Promoting teaching competency and effectiveness for the 21st century. American Association of Nurse Anesthetists, 67, 409-416. Good, D. M. & Schubert, C. R. (2001). Faculty practice: How it enhances teaching. Journal of Nursing Education, 40), 389-396. Hunsberger, M., Baumann, A., Lappan, J., Carter, N., Bowman, A., & Goddard, P. (2000). The synergism of expertise in clinical teaching: An integrative model for nursing education. Journal of Nursing Education, 39, 278-282. Johnsen, K. O., Aasgaard, H. S., Wahl, A. K., & Salminen, L. (2002). Nurse educator competence: A study of Norwegian nurse educators opinions of the importance and application of different nurse educator competence domains. Journal of Nursing Education, 41, 295-301. Kraft, S. K. (1998). Faculty practice: Why & how. Nurse Educator, 23, 45-48. Kubecka, K. E. (2004). Letters: From baccalaureate to the doctorate. American Journal of Nursing, 104(2), 15. Love, C. (1996). How nurse teachers keep up-to-date: Their methods & practices. Nurse Education Today, 16, 287-295. Mason, D. J. (2003). BSN-to-PhD programs: A bad idea. American Journal of Nursing, 103(10), 7. Miller, K. L., Bleich, M. R., Hathaway, D., & Warren, C. (2004). Developing the academic nursing practice in the midst of new realities in higher education. Journal of Nursing Education, 43, 55-59. Murphy, F. A. (2000). Collaborating with practitioners in teaching and research: A model for developing the role of the nurse lecturer in practice areas. Journal of Advanced Nursing, 31, 704-714. Myrick, F., & Yonge, O. (2005). Nursing preceptorship: Connecting practice and education. Philadelphia: Lippincott Williams & Wilkins.

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Nahas, V. L., Nour, V, & Al-Nobani, M. (1999). Jordanian undergraduate nursing students perceptions of effective clinical teachers. Nurse Education Today, 19, 639-648. National League for Nurses. (2004). Headlines from the NLN: Hallmarks of excellence in Nursing Education. Nursing Education Perspectives, 25(2), 98-101. National League for Nurses. (2005a). Core competencies of nurse educators with task statements. NLN publications. Retrieved January 25, 2006 at http://www.nln.org/profdev/corecompetencies.pdf National League for Nurses. (2005b). The scope of practice for academic nurse educators. New York: Author. Steele, R. (1990). Tips for nursing faculty entering clinical practice. Nursing Connections, 3(4), 39-41. Tang, F., Chou, S. & Chiang, H. (2005). Students perceptions of effective & ineffective clinical instructors. Journal of Nursing Education, 44, 187-192. Tanner, C. (1997). Teaching is a practice. Journal of Nursing Education, 36, 306307. Weitzel, M. (1996). Evaluation of clinical competency of clinical nursing faculty. Journal of Nursing Education, 35, 51-53. Zungolo, E. (2004). Faculty preparation: Is clinical specialization a benefit or a deterrent to quality nursing education? The Journal of Continuing Nursing Education, 35(1), 19-23.

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