Nursing School Dean: Interview with Robyn Nelson, RN, Ph.D.
Professional nursing is a lifelong educational journey
Robyn Nelson, RN, Ph.D., Dean, College of Nursing, West Coast University
Tell us about the general arc of your nursing career.
I actually entered college thinking I wanted to be an elementary school teacher. However, after observing a third-grade class during my first semester in college, I promptly changed my major to nursing!
After graduating from my BSN program and with clinical experience under my belt, I returned to graduate school for my M.S. in nursing with a joint focus: clinical nurse specialist in medical-surgical nursing and nursing education. I had a course in curriculum and instruction as part of my M.S. in addition to the clinical focus. Thus, I was prepared for service or education.
I completed my M.S. in nursing and began my job search, receiving several offers. I accepted a position with the California State University (CSU) system, teaching med-surg, fundamentals, OB and leadership at the undergraduate level — not all at once — and then moved to the graduate level, developing and coordinating the M.S. in nursing program.
Eventually, I became the chair of the CSU Sacramento nursing program for eight years and then was recruited to Nevada, where I became the dean of a college of health and human services (MSOT, DPT, nursing and education). It was my first experience with a private, faith-based educational institution.
Currently, I am the dean of the College of Nursing at West Coast University, a private, multi-campus system with four campuses and a fifth in development. We offer the BSN and MSN, providing access for students who might not otherwise have an opportunity to achieve their personal and professional goals of becoming registered nurses.
What led you to become a nurse educator?
As described in my answer to the first question, I believe I was called to be an educator. I found my way into nursing education because the thought of dealing with third graders five days a week was not appealing. While nursing students progress through definite developmental stages and sometimes their behavior mirrors that of elementary students — and certainly teenagers — nursing students are generally responsive to adult conversations.
I always felt I could influence changes in the delivery of care and best practices by preparing groups of nurses who practiced as I did, rather than one patient at a time in my clinical practice as a nurse.
You currently serve as dean. How long have you been in that position and what are your responsibilities?
I’ve been at my current university for two and a half years. Prior to that, I served five years as a dean over four disciplines and, eight years before that, over a large nursing program. I moved from a public educational system to a private system.
In terms of nursing education, what changes have you seen in the last decade or so?
There have been more applicants under the age of 30 entering nursing — likely because of the economic downturn. As has been said, healthcare is recession-resistant (but not recession-proof). Nursing needs younger nurses. However, the millennial generation feels entitled, which brings yet another set of challenges for educators.
There have been more issues observed and reported in the literature and by colleagues dealing with student conduct; cheating and plagiarism are two examples. When confronted with the pressure to succeed and the demands of nursing school, students appear to be making unwise choices to handle the stress.
There have also been more background issues, particularly DUIs. Our clinical partners must protect the safety of their patients, so we may not be able to place a student with a background issue for a clinical rotation. In some cases, if students have DUIs on their records within the last two years (and five years in some cases), we cannot place them. With a history of any petty theft or battery — even a misdemeanor — schools cannot place students for a clinical experience. Hospitals have come together to form regional consortiums to set background requirements and manage the increased number of students needing clinical rotations.
Many employers are stipulating that a BSN is preferred or required for employment. Obviously, as a BSN/MSN educator, I’m pleased to see this trend. Why should nurses have the least amount of education of anyone on the healthcare team?
How has technology impacted the education of nurses?
We need to prepare our graduates to use current technology, and simulation has become key to this form of educational experience. However, it’s expensive to build state-of-the-art centers with the high-fidelity equipment that’s necessary. There are many products that simulate what the student needs to know and do. There are even “virtual patients.” Many are reasonably priced and can be required just like a textbook.
A challenge with technology is that sometimes the clinical agency limits who can use the electronic health record [EHR]. This limits the ability of the student to develop competence in certain areas. Thus, the educational program needs to purchase a system so the student can practice using an EHR. Of course, the students are way ahead of many of the faculty members technologically speaking. Remember that the average faculty member is in his or her 50s and many deans are in their 60s!
One technology that I am trying to minimize the use of in the classroom is PowerPoint. To that end, we’re trying to “flip” the classroom and use more collaborative learning techniques, engaging the students in active learning. They have come into nursing wanting to continue the “scarf and barf” delivery method and it’s difficult and challenging to change how we teach and how students learn. Students demand PowerPoint in order to be told exactly what they need to know for the test. In that case, there’s not much critical thinking taking place, and we’re trying to change that.
Have more sophistiecated forms of simulation become an aspect of education at your school?
Yes, as mentioned above. West Coast University is fortunate to have amazing high-fidelity simulation centers available for student learning. We use the QSEN competencies as the basis for assessment of learning in the simulation experience. Simulation is a safe place to make mistakes and students appreciate the opportunity to demonstrate critical thinking in simulation scenarios.
Can you explain the QSEN competencies?
QSEN stands for quality and safety education for nurses, which includes knowledge, skills and attitudes [KSA] for pre-licensure and graduate nurses. The QSEN Institute has six pre-licensure KSA categories and we use these in our simulation and clinical assessments. The QSEN website [www.qsen.org] is very informative.
What is your opinion about growing calls for the bachelor of nursing degree to become the minimum standard of education for all nurses in the U.S.?
The Institute of Medicine (IOM) has really lit a fire under the need to raise the educational bar in nursing. As mentioned in my answer to a previous question, nurses have the least amount of education of any member of the health care team, but the nurse is the glue of the healthcare system. The BSN saves lives.
Flexner set the expectation for medical education in 1910 and 100 years later we have the IOM. I often refer to the IOM recommendations as the equivalent of Flexner for nursing.
I actually would support the community colleges offering the BSN. The faculty would have the same educational requirements as BSN programs, the programs would meet the same accreditation standards, etc. Then, there would only be one minimum educational preparation. Until that happens, we need to continue to support transition programs from the community colleges to university programs and set a requirement for the ADN graduate to return for the BSN, perhaps within 10 years.
A colleague of mine from the community college system partnered to develop the very first transition program from ADN to BSN in the state of California. Since then, there are new models. This is a topic I am very passionate about.
In educating your nurses, is self-care addressed in the curriculum?
Good question. We do cover life balance, stress management, healthful eating and exercise as well as role-modeling healthy lifestyle choices. However, the accelerated, rigorous curriculum and competing life demands make it difficult to consistently practice what is preached.
Additionally, are bullying and so-called horizontal violence addressed?
We recently distributed a survey to our students on this topic as part of a doctoral dissertation.
Do students report harassment or bullying by their clinical preceptors in the clinical setting?
They report difficult, non-supportive staff nurses, but not so much preceptors because a nurse who precepts has a choice to serve in that role. I am not aware of specific allegations.
A CNO colleague always starts her orientations for new hires by talking about how nurses eat their young and saying that new grads are not on the menu at her hospital. I have borrowed that line when I speak to students. We try to prepare them to respond to bullying behavior using “I,” not “you,” to express how it feels. We are looking forward to receiving the results of the dissertation study by Julie Vingers on the bullying of nursing students.
Are nursing schools beginning to address the recent growth of nurse entrepreneurship so that students understand their multifaceted career options beyond traditional nursing?
Our career services staff talks to students about looking outside the acute care setting. I always tell students that nursing is one education with a thousand career choices. I used to have a wonderful document that emphasized the transferrable skills a nurse has. For example, assisting a patient on and off the bedpan equated to making people comfortable in uncomfortable situations. I think a pre-licensure program focuses more on preparing for a role as a beginning practitioner in nursing and less on entrepreneurship. Nursing still values time in the trenches in terms of professional credibility.
What is about nursing education that feeds your spirit?
As the tag line on my email says, “Students don’t interrupt my work … they are my work.”
I look forward to attending the pinning ceremonies and listening to the student speakers who are so eager to enter the profession. I enjoy the emails from students saying thank you, and I am thrilled when a former student joins me as an officer of a professional organization, applies for a faculty position or becomes the head of a department in one of our clinical agencies. I know the communities our students serve are in good hands.
Do you encourage nurses to consider nursing education as a career path?
All the time! My comments to students at pinning include saying that professional nursing is a lifelong educational journey and they are not only the future of professional nursing, but also the future of nursing education! They are the future faculty.
In this regard, one of the challenges is the salary disparity between clinical nursing and careers in education. While my institution pays faculty a very reasonable salary, they can honestly earn more in clinical practice.
We have a large number of faculty members who teach part time while working full time in a clinical setting. It is a great benefit to our students to learn from professionals who are actively practicing in the field, but we must also cultivate more full-time faculty with expertise in curriculum development, program assessment, student remediation and governance. Another issue is that an excellent clinician is not necessarily an excellent teacher; they need mentoring and role-modeling in terms of being educators.
My point is that we need full-time faculty and we must spend time transitioning them from the clinical setting to the classroom. Also, my advice to nurses returning for the MSN is to be sure to take a curriculum and instruction course with practice teaching — you will be better prepared for a faculty position.
What are your future career plans?
My future plans include retirement as well as returning to Sacramento State as a retired annuitant. I have too many nursing friends and colleagues who have “failed” retirement, so time will tell for me. I also plan to take the certified nurse educator certificate exam just because I want to.
Keith Carlson, RN, BSN, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.