A neglected transition in nursing: The need to support the move from clinician to academic properly

Throughout their career nurses may go through several transitions, the most commonly discussed is the move from student status to that of a newly Registered Nurse—with a substantial literature on how this change can be a source of stress (Haplin, Terry, & Curzio, 2017; Suresh, Matthews, & Coyne, 2013). However, this literature has moved beyond identifying the difficulties inherent in this process to suggesting strategies to address the problems associated with this aspect of significant change (Hofler, & Thomas, 2016; Suresh et al, 2013). In this editorial we argue that there is a need for more work to address the comparatively neglected transition from clinician to academic. There is certainly a body of literature that identifies that this change is problematic, having been described as on par with drowning (Anderson, 2009). This description from a decade ago gives a real perspective to how arduous the move from nursing practice to education can be. More recently, Grassley and Lambe's (2015) exploration of this transition, ‘undertaken out of genuine concern’, would seem little has changed in the problems faced by new nurse lecturers. For example, new nurse academics can face a clash of cultures when moving to academia – skilled clinical teachers can meet alternative pedagogical approaches in academia that create tension, and lead to a loss of confidence – an issue that has been shown to affect many new nurse academics (Duffy, 2013; Logan, Gallimore, & Jordan, 2016; Weidman, 2013). Although they may be competent teachers in practice, the challenges of formal teaching in academia and the numbers of students involved may mean new academics are ill-prepared for this new role (Grassley & Lambe, 2015). However, we believe the issue that affects transition is more than a pedagogic one – it is also the loss of one identity, and the search for a new one, becoming and ‘owning’ the identity of an academic. This is where nursing differs from medicine. Academic medical staff members develop roles that blend clinical and academic work – not so nursing in many contexts. Therefore, the transition is more marked – not unlike a grieving process. Academic workloads often mean there is little time (or encouragement) for new nurse academics to maintain their clinical skills. This striving to become an effective teacher and academic therefore can place them at odds in maintaining clinical credibility (Andrew & Robb, 2011). This loss of professional identity from the clinical role is a ‘sense of loss’ (Duffy, 2013) and a loss of the security of all that is familiar (Anderson, 2009). When professional identity defines who we are, then it should be appreciated new nurse lecturers can find themselves in a no-man's-land: No longer in clinical practice can mean a loss of credibility with nursing colleagues, while not being established as an educator and researcher means they can lack relevance in the world of academia. We also believe that the transition is also problematic as it requires new nurse academics to engage with research or scholarship, often for the first time. This can also be a steep-learning curve and a source of stress alongside development as a teacher. In the UK, new nurse academics do not easily fit into the systems and support structures designed for new academics in other disciplines who have had a more conventional route into academia. In nursing, the rationale for an appointment may be related to the need to fill a teaching requirement on a programme – this then takes precedent over recruiting a researcher. This needs to be recognized in early career nurse academics and support to develop as a researcher seen as a development need as vital as developing as a teacher. The fact that academia is a second career for many nurses means they have a different career trajectory to that of other academics – they often lack a PhD on entry to their academic jobs. Help to achieve a doctoral level qualification is therefore an important part of the assimilation to an academic for nurses – and an important signal that the discipline of academic nursing should – eventually have an all doctoral membership. The value of mentorship and collegiate support has been described as invaluable for new nurse lecturers (Anderson, 2009; Duffy, 2013; Logan et al., 2016; McDermid, Peters, Daly, & Jackson, 2016; Weidman, 2013). Without this in place, the transition can be far more demanding and stressful (Weidman, 2013) proving that some form of structured support is beneficial to not only ease the transition, but to help maintain psychological and emotional health and well-being. Engaging with collegial support is a major factor to help novices develop their resilience (McDermid, 2016). The benefit of this reduces stress and burn-out (Weidman, 2013). Those new academics who receive adequate support become more confident and competent, which directly correlates with mentorship and proficiency (Weidman, 2013). Self-reflection, and the art of reflection is an integral aspect of being a nurse, and its value can aid the progression of this transition, and the adoption and acceptance of the new role of ‘being’ an academic (McDermid et al., 2016). The ability to reflect on one's personal and professional development can be empowering and can help motivate and sustain achievements. Gaining experience in the new role and becoming more familiar with lecturing can help foster feelings of being more comfortable in the new professional skin. Given that it has been identified that it can take a new academic anything from 2-4 years to settle into their new role, (Dempsey, 2007) then promoting the adoption of the reflective process should be encouraged in order to facilitate the integration. This suggests some value in exploring the provision of formal or informal support structures to promote the well-being of new nurse academics to help retain their employment. However, a sympathetic approach is only of benefit to the novice when adequate collegial connections and assistance is in place to smooth the transitional period. In order to support new nurse lecturers, universities must therefore recognize the stark contrast between clinical practice and the demands of academia and its unique processes. Without this in place, the problematic transition period for new academics will continue to be an issue. So how might those who are struggling move on help themselves? We suggest it is easy to get entrenched in negative thinking. Looking back wistfully to clinical practice can only compound the feelings of loss and the ability to embrace the new identity of nurse lecturer. It is about recognizing the rewards of shaping the nursing workforce of future, sharing knowledge and experience to help ensure high-professional standards. Forging relationships to ensure collegiate support and role-modelling can help develop resilience which is a key part to surviving the transition (McDermid et al., 2016). However, it is not just for the novice to do all the work. To aid retention, and ease transition, universities have a responsibility to ensure a mutually beneficial long-term induction process tailored to the individual (King, Roed, & Wilson, 2018). We suggest the following as key components in the support structures new nurse academics require during their transition from practice to education: This is invaluable in aiding retention of new academics, because it reduces the stress of transition. Those who have adequate support in place, feel confident and competent. It directly correlates with mentorship and proficiency, when those who have little or no support experience increased stress and burnout (Weidman, 2013). Those who do not have mentorship in place report adverse effects on both their physical and mental health (Weidman, 2013). Clearly, not only is this counterproductive, it is unacceptable in any workplace for adequate support systems to not be in place. The adage that nursing eats its young should not be allowed to transfer into academia. An absence of team working, and a more autonomous approach to work, can be an alien concept when compared to the cohesion of the multi-disciplinary teams of the NHS. This can compound the sense of loss through feelings of isolation; therefore, forging new friendships and alliances is integral to ‘belonging’ (McDermid et al., 2016). Without this, the new academic is unlikely to move away from the familiarity and comfort of practice. The adoption of role modelling and opportunities to observe experienced nurse lecturers in action can give novices something to relate to and helps the development of an academic identity (Logan et al, 2016). Integration into a new role naturally evolves from repeated exposure to situations (Anderson, 2009). Accustoming to pedagogy and the art of lecturing will help novices move forward. The next step is assimilation and adoption of the identity of academic by embracing the culture of academia. Acceptance of the new professional identity will directly correlate with the intent to remain within academia, and eventually effectiveness and success within it (McDermid, 2016). This will help create stability and a feeling of affiliation (Duffy, 2013), and ultimately job satisfaction. Whilst leaving one speciality for another is commonplace in clinical practice (Portoghese, Galletta, Battistelli, & Leiter, 2015), the move to academia would appear to demand greater personal resilience. The loss of patient contact and clinical practice can trigger a grieving process (Boyd et al, 2009), compounded by a reticence to accept the label of academic. This loss of identity can be problematic and is unique to nurse lecturers (Boyd and Smith, 2016). However, nurses may be their own worst enemy by focusing on what they have lost, rather than concentrating on the positives of their transferable skills. This only serves to complicate and prolong the transition. Therefore, support is vital to lessen the impact of lost identity (McArthur-Rouse, 2008). The literature demonstrates novice academics lose sight of their existing knowledge and skills, which they have in abundance. Therefore, the value of clinical supervision is not to be underestimated, especially if it aims to link the competencies required by academia with those from practice (Schaar, Titzer, & Beckham, 2015). Its value is a smoother transition period, which in turn aids retention of the new academic. Human factors aside, this is important when the expense of recruitment and training are considered. New academics need to know they are worthy of individualized investment and support to help them be successful (Goodrich, 2014). They must be afforded the time and supportive resources to help develop them as the next generation of researchers (Logan et al., 2016). Nurses have resilience in abundance (Holtz, 2018); however, the stress and confusion of transition can exceed personal resources to cope with the demands placed on them (Logan et al., 2016). The value of clinical supervision is the supervisee's performance is the focal point. In conjunction with reflection, the positive benefits of guiding the novice to recognize they are developing new skills would be a supportive and ongoing process. Its use in secondary school educators has already demonstrated success in enabling teachers to develop their practice and become increasingly effective and confident (Veloo, Komuji, & Khalid, 2013). There is no reason why this would not also transfer into HEI and its adoption is proposed here. We propose the adoption of clinical supervision in HEI