Extent of Collaboration in Building Academic – Service Partnerships in Nursing

Background: There is a growing concern in the nursing service industries to expand the roles of nurses. A well-developed and planned collaboration between the academic and services in nursing is required. Purpose: This study investigated the extent of collaboration in building academic-service partnerships based on the perceptions of the students, faculty, staff nurses, and nursing administrators. Methods: This study employed a descriptive research design to obtain a thorough picture about the extent of collaboration in building academic and service partnerships. The majority of the participants (n=500) were staff nurses (n=232, 46.4%) from 5 hospitals, students (n=160, 32%) and faculty (n=62, 12.4%) from 7 schools who were informed, consented and selected using a purposive sampling. A questionnaire was used to describe the extent of collaboration. Descriptive statistics such as mean, standard deviation, frequency, and the percentage were used. Results: Students, faculty, nursing administrators and staff nurses assessed the overall extent of collaboration in building academic-service partnerships to a great extent in terms of nursing education redesign, research collaboration, faculty practice, academic and clinical progression, and workforce development. Conclusion: Despite the fact there was a great extent of collaboration in building academic-service partnerships in nursing, the proposed intervention or enhancement program can be an instrument to strengthen the current status of nursing amidst radical reforms in the healthcare delivery.


RESULTS
The findings of this study revealed that the participants evaluated the extent of collaboration in building academic ± service partnerships as being met to a great extent referring to the nursing education (M=3.92, SD=0.72), research collaboration (M=3.76, SD=0.61), workforce development (M=4.02, SD=0.67), academic and clinical progression (M=3.96, SD=0.57), and faculty practice (M=4.05, SD=0.67). Furthermore, the results revealed that in nursing education, participants agreed that both academic and service institutions in nursing collaborated to have a deep understanding of the enduring concepts of the discipline, as anchors for the many details students must learn (M=4.17, SD=0.71).
In research collaboration, participants agreed that both academic and service institutions introduce nursing research and its contributions to healthcare outcomes (M=3.94, SD=0.71). In terms of workforce development, participants understood that both academic and service institutions work on a cooperative mechanism between the employers and employees to the potential workers and create a continued commitment and loyalty to the institution (M=4.10, SD=0.82). In terms of academic and clinical progression, the collaboration was done through partnering with practice colleagues to design creative collaborative initiatives to assure that the graduates are prepared to practice and to progress in their nursing education (M=4.18, SD=0.68). Lastly, there was an evidence that formal communication processes between the clinical faculty coordinators and clinical instructors/teachers were regularly conducted as agreed by the participants in building academic ± service partnerships (M=4.14, SD=0.67).  Table 1 presents the extent of collaboration in building academic-service partnerships in terms of nursing education redesign. The overall mean of 3.92 reflected a great extent of evaluation. Furthermore, it can be inferred, there was a deep understanding of the enduring concepts of the discipline, as anchors for the many details students must learn (M=4.17). In a rapid change of the healthcare delivery, nursing education institutions are required to produce highly skillful, innovation-driven, efficiency-driven, and results-Nurse Media Journal of Nursing, 6 (2), 2016, oriented practitioners in a highly regulated environment (Boller & Jones, 2010). In addition, Frank (2008) surmised that effective partnerships could benefit both students and the agencies where clinical experiences take place. He further posited educators and service personnel must fully collaborate to provide the best education for future practitioners. In this regard, nursing education redesign aims to critically examine and identify the best teaching modalities and develop more effective and efficient methods to educate students. This domain aims to build collaborative, systematic, ongoing, and evidence-based approaches that assure a well-prepared nursing workforce will take the lead in optimizing the health of today and in the emerging future (Boller & Jones, 2010). With this, nursing education redesign is significant to be part of the collaboration between academic and service institutions in building a partnership. Nursing education needs to consolidate efforts with the nursing service because they are both responsible and accountable for the development of lifelong learning, holistic preparation and practice orientation of graduate nurses from transitory to practice. Becoming adaptive, responsive, integral component of the society and healthcare system are the key attributes of nurses who are locally and globally competent, conscientious, compassionate, and caring. Table 2 presents the extent of collaboration in building academic-service partnerships in terms of research as part of the academic-service partnerships. Overall, participants

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Furthermore, it can be gleaned in the results that participants agreed that academic and service institutions introduce nursing research and its contributions to the healthcare outcomes (M=3.94). The nursing research has become integral to the development of any KHDOWKFDUH V\VWHP ¶V VDIHW\ DQG RYHUDOO TXDOLW\ $FDGHPLF-service partnerships are an essential tool for initiating and realizing this paradigm shift. The nursing profession will play a key role in the process of redesigning the practice environment to bridge the gap between the fragmented care and the integrated multidisciplinary care processes, as the nurse is most closely connected to both the patient and the healthcare team (Institute of Medicine (IOM) 2010).
Effective collaboration involves the interplay between the teams of interdisciplinary professionals, the organizational environment they practice in and the underlying cultural expectations that presuppose the possibilities for collaboration (Bender, Connelly, & Brown, 2013). Research capacity building engenders assets that allow communities to respond adequately to health issues and problems that are contextual, cultural and historical in nature (Airhihenbuwa, 2011). Henoch et al. (2014) concluded that nursing education has the potential to poVLWLYHO\ LQIOXHQFH WKH QXUVHV ¶ DWWLWXGHV WRZDUGV QXUVLQJ research and evidence-based practice, which could result in better patient outcomes. Table 3 presents the extent of collaboration in workforce development. Overall, SDUWLFLSDQWV DVVHVVHG WKH IDFXOW\ SUDFWLFH DV EHLQJ PHW WR D ³JUHDW H[WHQW 0 SD=0.67). The results also revealed that the participants were working on a cooperative mechanism between the employers and employees to the potential workers and create a continued commitment and loyalty to the institution (M=4.10). A key focus of concern in relation to the future shape of the nursing workforce internationally and nationally has Nurse Media Journal of Nursing, 6 (2), 2016, been the perceived high attrition rate of graduates. This concern has been accompanied by a plethora of literature on the graduate transition to practice. Many of studies have been carried out from the perspective of the employing organization and look at the graduate turnover, intent and retention strategies within the first year of practice (Scott et al., 2011).

Workforce Development
The Institute of Medicine (IOM) (2010) reported four key essential perspectives that would innovate the roles and functions of nurses as follows: (a) nurses should practice to the full extent of their education and training; (b) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; (c) nurses should be full partners with physicians and other health professionals, in redesigning health care in the united states; and (d) effective workforce planning and policymaking require better data collection and an improved information infrastructure. Many studies have been conducted examining the factors in reducing the nursing shortage and would facilitate the workforce development including the graduate transition to practice, turnover intent and recruitment and retention strategies, from an employer perspective. These studies have usually focused on the retention in the first year following graduation (Gaynor et al., 2006;Rydon, Rolleston, & Mackie, 2008;Salt, Cummings, & Profetto-McGrath, 2008). The workforce development in nursing, leaders and policymakers are in the process of bridging the gap between theories and practice that will align the local and global needs for nurses as a growing body of the healthcare workforce. Table 4 describes the extent of collaboration in academic and clinical progression. 2YHUDOO WKH SDUWLFLSDQWV DVVHVVHG IDFXOW\ SUDFWLFH DV EHLQJ PHW WR D ³JUHDW H[WHQW 0 SD=0.57). Partners work with practice colleagues to design creative collaborative initiatives to assure that the graduates are prepared to practice and to progress in their nursing education. (M=4.18, SD=0.68). Despite a great extent of collaboration revealed in the findings, championing multi-site, research initiatives designed to test and evaluate the academic progression of students in BSN program were identified to have the lowest mean among the other indicators (M=3.70, SD=0.78). This reflects that in the academic community, there is a little evidence of developing a system from which graduates are monitored. The common measures of academic progression to date in the country include academic performance, clinical evaluation, and the licensure examination. Few of the nursing schools are conducting tracer study to look into the success of the students from transitory to practice. Thus, both academic and service institutions need to develop the partnership to orchestrate the art and science of nursing in the preparation of nurses and future of nursing. Wolff et al. (2012) pointed out the agreement about the meaning of new graduate nurses' readiness for practice as having a generalist foundation and some jobspecific capabilities, providing safe client care, keeping up with the current realities of nursing practice, being well equipped with the tools needed to adapt to the future needs of clients, and possessing a balance of doing, knowing, and thinking. Table 5 presents the extent of collaboration in the faculty practice. Overall, participants DVVHVVHG WKH FROODERUDWLRQ DV EHLQJ PHW WR D ³JUHDW H[WHQW´ 0 6' 0RUHRYer, as agreed by the participants, there were formal communication processes between the clinical faculty coordinators and clinical instructors/teachers which were regularly conducted (M=4.14, SD=0.67). The faculty practice as an interaction performed for or on behalf of clients and various roles are integrated such as consulting, teaching, research, caregiving, or counseling (Beal et al., 2012). Many authors concluded that faculty practice has many benefits, which include cost effectiveness, good patient outcomes, positive student learning, increased research productivity, and faculty satisfaction (Beal et al., 2012). The preceptor role in undergraduate nursing education is complex and multifaceted. The undergraduate nursing students identify preceptors as a key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role (McClure & Black, 2013).

Faculty Practice
According to Roberts, Kasal and Flowers (2013) the ability to respond to the increasing need for nurses is directly related to the availability of adequate numbers of faculty. One solution that is currently being utilized by many educational institutions is the employment of adjunct clinical faculty. As more and more adjunct clinical faculties are being used to educate nursing students, the manner in which these clinicians are being prepared for an educator role must be examined. Based on their findings, the participant perspectives revealed that their transition from a nurse clinician into the role of adjunct clinical faculty is one that should be intentionally guided and supported by a mentor, with a focus on the acquisition of educational skills needed for that role. Cranford (2013) stated that one solution to the faculty shortage is to recruit faculty from clinical practice. This often becomes problematic resulting in intent to leave academia within five years. The possible factors contributing to this action are role ambiguity and role strain. Ferguson, Haantjens, and Milosavljevic (2014) evaluated the role of the clinical educator position in a specific teaching hospital setting on its ability to increase clinical student supervision capacity while maintaining staff productivity and sustaining staff morale. The faculty practice partnerships offer a feasible, cost-effective option for the promotion of the staff development quality in the face of constrained health care and educational resources. The faculty practice can add significantly to the dimensions of educator roles. Services in a healthcare organization in clinical, research, or administrative roles add a realistic and broader dimension to the faculty member's perspective on social issues. Thus, the partnership built on collaboration would greatly impact both the academic and service institutions in achieving the goals of preparation and practice orientation for the next generation of nurses and nursing community.

Proposed Enhancement Program in Strengthening Academic±Service Partnerships in Nursing
This enhancement program covers areas that are timely and necessary to address the complex issues in nursing. In nursing education redesign, coordinated and continuous dialogues will identify gray spots to be improved. In research collaboration, the operationalization of research related activities is imperative along with the implemented of research agenda blueprint. It can be seen also from the figure that the academic faculty has significant roles in the development of a learner-centered environment through a reexamination of modalities, content inclusion in the course, and the program as a whole.
Nurse Media Journal of Nursing, 6 (2), 2016, The part of the faculty roles is the continuing education that will make the academic community to be abreast with issues, concerns, and challenges.
The transition from clinical staff to having academic roles and the inclusion of being mentors to the students and other stakeholders require a continuing orientation plan. There is scant evidence in the area of academic-clinical progression in relation to the building of collaboration. Thus, it can be integrated into some areas for appraisal, which include a multi-site research identifying the concepts of transitory to practice. Nursing graduates are expected to develop knowledge, skills, and attitudes. With this, conformity to both national and international standards in nursing practice is required. Both academic and service institutions in nursing are striving to meet the challenges associated with globalization and the increasing demands on the healthcare delivery systems. On the other hand, nursing is not a standalone profession to experience the mounting oddities and issues. In fact, many academic disciplines are in the process of restructuring its system to meet the ever-changing local and global demands based on the service needs. In nursing, collaboration has been conceived as a significant instrument to facilitate the growth of scholarship in teaching, research, and practice. For instance, in nursing education, the partnership built in collaboration with the nursing service provided a platform on how both organizations can become more proactive and reactive to the rapidly changing environment. Academic and service partnerships enable the realization of providing quality education and quality services through a continuous revisit in the following areas including nursing education redesign, research collaboration, faculty practice, academic and clinical progression, and nursing workforce development. The proposed academic service collaborative partnerships in nursing is further described in Figure 1.

CONCLUSION
The study revealed that the students, faculty, nursing administrators and staff nurses showed a great extent of collaboration in terms of nursing education redesign, research collaboration, faculty practice, academic and clinical progression, and workforce development. This study proposes an enhancement program in building academic ± service partnerships in nursing which can be an instrument to strengthen the current status of nursing amidst radical reforms in the healthcare delivery.