Utilization of retired physicians as nursing faculty

doi:10.4236/ojn.2013.37065

Paper Menu >>

Journal Menu >>

Open Journal of Nursing, 2013, 3, 481-484 OJN

http://dx.doi.org/10.4236/ojn.2013.37065 Published Online November 2013 (http://www.scirp.org/journal/ojn/)

OPEN ACCESS

Utilization of retired physicians as nursing faculty

Patricia L. Starck1, Shelly Liss2, Gerda Gomez1, Michael E. Speer3

1The University of Texas Health Science Center-Houston School of Nursing, Houston, USA

2Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, USA

3Departments of Pediatrics & Ethics, Baylor College of Medicine, Houston, USA

Email: [email protected]

Received 13 September 2013; revised 12 October 2013; accepted 28 October 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The nation’s nursing shortage is predicted to worsen,

as nurses retire (supply) and more patients have ac-

cess to care with the full enactment of the Affordable

Care Act (demand). Schools of nursing are under

continuing pressure to increase enrollment in entry

level nursing programs [1-4]. Nurse educators have

been engaged in a variety of creative and innovative

projects to increase enrollment with some success. A

primary reason for the lack of educational capacity is

the shortage of nursing faculty [3-7]. The University

of Texas Health Science Center-Houston School of

Nursing undertook an innovative project to alleviate

the nursing faculty shortage at that school. Working

with a retired physician group, physician volunteers

were solicited to teach in the laboratory portion of an

undergraduate health assessment course. Twenty-two

physicians volunteered in the first year in a class that

involved forty baccalaureate students in their first-

semester. The objectives of the project were twofold:

First, to determine the suitability of retired physi-

cians to serve as teachers of baccalaureate nursing

students and second, ascertain possible monetary

savings by using these physicians. Both of these goals

were realized. The students valued the physicians’

enthusiasm, wisdom and experience and the cohort of

physicians equaled the equivalent of four nursing

faculty members. With an average annual faculty

salary of $100,000, savi n gs were significa nt .

Keywords: Retired Physicians; Supply and Demand;

Nursing Faculty Shortage

1. INTRODUCTION

There is both an acute and chronic shortage of nurses in

the United States [1-4]. Janiszewski determined that the

four most important causes for the shortage were the

aging workforce (In 1980, 25.1 percent of Registered

Nurses were under the age of 30 compared to only 9.1

percent in 2000 [5]), declining enrollment in schools of

nursing, the changing work climate, and the poor image

of nursing [3]. Indeed, there are many more career op-

portunities for women in the work force over the last

quarter century, particularly within the field of nursing

itself [4]. The shortage is particularly troublesome in

Te x a s ( Figure 1), and schools of nursing are under con-

siderable pressure to increase enrollment in entry level

nursing programs. There are adequate applicants for a

field projected to need an increased labor force. The

problem is in educational capacity. Specifically, the issue

is an inadequate supply of nursing faculty [5-7]. Nurse

educators have engaged in various sorts of creative and

innovative projects to produce more with less, as well as

to invent new models of nursing education [7]. Use of

regularly employed nurses as preceptors, use of part-time

or contract nursing faculty, use of “loaned faculty” by

hospitals, etc. have been tried with varying levels of suc-

cess and sustainability.

2. METHODS

As a result of a casual conversation, the leadership of the

University of Texas Health Science Center-Houston

School of Nursing evaluated the idea that retired

physicians might be able and willing to volunteer their

time to teach nursing students. First, enquires were made

to the Texas State Board of Nursing to determine whether

retired physicians could teach entry level baccalaureate

nursing students. The Board determined that they could

independently teach non-clinical nursing courses, but not

clinical courses unless it was as a co-teacher with a

nursing faculty member. Of note, it also was determined

that physicians who participate in clinical nursing

education are not required to maintain malpractice

insurance. The Executive Vice President for Academic

Affairs of the University System, a physician, also

P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484

482

Figure 1. Projected supply and demand for nurses in

Texas.

endorsed the concept. After consideration of the options

and best fit, it was proposed that retired physicians be

invited to teach the laboratory component of the basic

undergraduate adult and pediatric health assessment

course which is in the first semester of the curriculum.

This course consisted of two hours of didactic work per

week and three hours in the laboratory conducting a

health history and physical exam. Fellow students, pro-

grammable manikins, and community citizens served as

patients, with creatively arranged symptoms and reac-

tions that generally reflect a combination of pathophy-

siologic processes.

The Retired Physician Organization (RPO) of Harris

County, Texas, a component of the Harris County Me-

dical Society with over 500 active members, was ap-

proached for a possible source of volunteer physicians.

Utilizing a project management liaison to serve as a

bridge between the School of Nursing (SON) adminis-

tration and faculty and the RPO, volunteer physicians

were recruited using the following criteria:

 Retirement within the last five years, or other evi-

dence of staying current with medical practice.

 Teaching experience preferred.

 Computer skills preferred.

In the first semester, there were four lab sections of 10

students each. A course grid was prepared, and the phy-

sicians were asked to sign up for one or more individual

laboratories.

Before the start of the course, a mandatory 3-hour phy-

sician orientation was conducted that focused on under-

standing current nursing practice, today’s student mores’,

the school’s philosophy, and the class curriculum. An

optional 2-hour “refresher course” on physical assess-

ment also was offere d.

As the physicians needed to know exactly what they

were expected to do in the labs and the depth of assess-

ment skills needed to teach beginning nursing students,

they were asked to review learning objectives for each

laboratory and review the assessment skills demons-

tration videos before the laboratories. Weekly reminder

emails were sent to the physicians who would be teach-

ing the upcoming week with lab schedules, learning

objectives, links to review video, and details of skills

covered. The physicians were held accountable for their

attendance and for finding replacements when they had a

change of plans. To ensure consistency of content taught

to the students, each lab began with a demonstration

video, followed with a questions-and-answers session.

Initially, the students were then divided into pairs to

practice physical examination techniques on each other.

Later, the students used programmable manikins, and

live patients with specific scenarios. The physicians

would circulate around the laboratory space to supervise

the progress. One nursing faculty floated between four

laboratory areas. Following class, students were given

one week to finish their assessment write-ups and give

them to the faculty that taught that particular laboratory

session.

3. LESSONS LEARNED

Studies about physician retirement have indicated that

physicians desire meaningful work [8,9]. Indeed, phy-

sicians expressed their satisfaction in being able to pass

along their skills they had honed over decades of prac-

tice.

While the RPO’s leadership felt that the pilot project

was appropriate for their members, the members them-

selves, due to their many other activities, could not each

teach a whole course [8,9]. They did agree that a group

of physicians could each teach a single laboratory course

module, particularly in an area that matched their clinical

specialty interest. Initially, 22 physicians volunteered to

participate; another 11 joined the program later. Some

physicians volunteered for one laboratory session, some

for six.

As noted, all volunteer physicians participated in the

orientation. Of interest is that all also took part in the

optional refresher course on physical assessment. The

physicians were observed to be very conscientious in

their new role in requesting copies of student assign-

ments, both written materials as well as the online sub-

ject matter. They generally arrived early before the lab

started. There were no instances where the physicians

failed to either appear in person or find an alternative if

there was a change in their personal plans.

Student interviews also reflected very positive res-

ponses to the change in instruction. Besides developing

their clinical skills, they stated that working with the

retired physicians offered an invaluable introduction to a

mutually respectful physician/nurse interaction and made

them very comfortable talking with physicians.

Traditionally, students were given one week to finish

their written assessments. However, with a different

P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484

483

physician teaching in every lab, students did not have the

advantage of seeing the same instructors every time they

returned to the laboratory. As a consequence, students

could not turn in their papers to the instructor who

supervised their practice in the content areas they were

writing about. It was suggested that the students com-

plete their write-ups within the laboratory session. How-

ever, the students had difficulties completing their review

of systems and physical examination within the three

hours available for the laboratory. While some retired

physicians offered their email addresses for students to

send their papers after laboratory hours, this was not

possible for all. In the latter case, nursing faculty graded

the assessments. This problem was solved the next se-

mester when a nursing faculty member was paired with

each laboratory section and the students gave their pa-

pers to the nurs i ng fa culty the next week.

4. EVALUATION

In evaluating the experience, the physician questionnaire

responses showed that the physicians were very positive

in being given the opportunity to share the knowledge

and expertise acquired over 40 years with a younger

generation and thereby have a positive impact on future

patient care. While they admitted to a sense of unease

prior to their first teaching experience with nurses, their

comfort level immediately improved after seeing the

students’ obvious pleasure at having experienced, knowl-

edgeable physicians present at their earliest educational

experience. The questionnaire also reflected that the phy-

sicians were still somewhat uncertain as to exactly what

their role should be.

Evaluation focused on the two objectives of effective-

ness and cost savings. Evaluations of both the physicians

and students were performed. After the end of the course,

a questionnaire was mailed to the participating physi-

cians and interviews were conducted with the students.

The cost benefit analysis showed a financial benefit to

the School by using retired physicians as adjunct faculty.

The savings were calculated by determining the number

of nursing faculty replaced to conduct the laboratory

sessions minus the cost of the pilot program. Expenses

included compensated p arking, orientation packets, refresh -

ments, a luncheon given at the end of the semester and

appreciation gifts (mementos), and a small fee paid to the

project liaison for a total of less than $4000 . Not counted

were the costs associated with administrative time spent

in recruiting faculty or coord inating schedules.

5. DISCUSSION

The number of volunteer physicians (22) initially re-

sulted in an increased time commitment for the Nursing

School’s faculty to coordinate the different teachers with

the different students. This work load was greatly red uc ed

by using the project management liaison who took over

this aspect of the course.

In the laboratory component of the basic undergra-

duate adult and pediatric health assessment course, ge-

neral health assessment and physical examination tech-

niques are covered. Traditionally, students would have

the same instructor throughout the semester for the labs.

As most of the physician volunteers were specialists,

there was initial concern that the physicians would only

related that any disadvantage that this caused was more

than compensated by having a specialist for each topic.

The physicians’ ability to provide guidance in devel-

oping physical exam skills helped the students accom-

plish the examination with more self confidence and

awareness of the “real” world beyond school. Creating a

mutually respectful physician/nurse interaction is diffi-

cult to replicate in the actual hospital setting due to

accessibility and time constraints but is critically impor-

tant for appropriate team management. This was not

difficult in the described environment. Furthermore, the

students learned about the diseases and treatments from

the medical side as well as from the nursing perspective.

This allowed the student to fully integrate the concepts of

disease management.

Post pilot project, the specific role of the retired phy-

sicians in the educational process was evaluated by the

project team. Indicators of the project’s success were

demonstrated by the feedback from both the students and

physicians; 30 physicians volunteered to teach the fol-

lowing semester. The physicians have been integrated

into other aspects in the life of the school, including so-

cial events. Seminars have been held for physicians,

including one as “Understanding generational differ-

ences”.

Another consideration for the future is to examine the

expectations of the nursing school faculty and the vol-

unteer physicians. Considerable time was spent by the

project management liaison contacting individual phy-

sicians, who had volunteered but wer e of town or out the

country, to determine when they were available for the

following semester. Further anticipatory development of

course curriculum will permit physicians to plan ahead

and facilitate their involvement. It should be noted that

once contacted the physicians enthusiastically expressed

a desire to continue their participation.

The program began in 2008 and has settled in to a

standard part of the BSN degree program. The class size

has grown to 120 students. There have been some at-

trition and change, including two deaths, but new volun-

teers have also joined.

The inclusion of retired physicians into the teaching

environment of the SON has been an extremely enrich-

ing experience for our students and faculty and utilizes

P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484

484

an under realized resource. Although not without its chal-

lenges, such programs can serve to alleviate, at least in

part, the shortag e of nurse faculty in this country.

REFERENCES

[1] Texas Nursing Education Capacity Team (2012). Texas

nursing: Our future depends on it. A strategic plan for the

state of Texas to meet nursing workforce needs of 2013.

www.dshs.state.tx.us/chs/cnws/TexasTeam/TexasStrateg

y.pdf

[2] Texas Nurses Association (2010). RN supply & demand.

http://www.texasnurses.org/displaycommon.cfm?an=1&s

ubarticlenbr=82

[3] Janiszewski, G.H. (2003) The nursing shortage in the

United States of America: An integrative review of the

literature. Journal of Advanced Nursing, 43, 335-343.

http://dx.doi.org/10.1046/j.1365-2648.2003.02722_1.x

[4] Fitzpatrick, J. and Emerson, E.E. (2011) 201 careers in

nursing. Springer Publishing Company, New York.

[5] United States General Accounting Office (2012) Nursing

workforce: Emerging nurse shortages due to multiple fac-

tors. United States General Accounting Office Report to

the Chairman, Subcommittee on Health, Committee on

Ways and Means, House of Representatives.

http://www.gao.gov/new.items/d01944.pdf

[6] Reinert, J., Bigelow, A. and Kautz, D.D. (2012) Over-

coming nursing faculty shortages and bridging the gap

between education and practice. Journal for Nurses in

Staff Development, 28, 216-218.

http://dx.doi.org/10.1097/NND.0b013e318269fc6c

[7] Tanner, C.A., Gubrud-Howe, P. and Shores, L. (2008) The

Oregon Consortium for nursing education: A response to

the nursing shortage. Policy Politics Nursing Practice, 9,

203-209. http://dx.doi.org/10.1177/1527154408323043

[8] Virshup, B. and Coombs, R.H. (1993) Physicians’ ad-

justment to retirement. Western Journal of Medicine, 158,

142-144.

[9] Liss, S.E., Cohen, I.M. and Charalampous, K.D. (2001)

Insights into physician retirement. Texas Medicine, 97,

72-74.