1 INTRODUCTION

Considering the complexity of the nurse educator role, experienced nurse clinicians who choose to transition to the novice nurse educator (NNE) role ought to be adequately prepared with the requisite pedagogical knowledge, attitudes and skills to make the transition easier and successful (Booth et al., 2016; Marfell et al., 2017; Smith et al., 2019). However, international studies have revealed that not all NNEs recruited into Health Training Institutions (HTIs) are adequately prepared and they often struggle to transition into their new educator role (Brown & Sorrell, 2017; Cooley & De Gagne, 2016; Grassley & Lambe, 2015; Miner, 2019). This contributes to role strain, frustration and dissatisfaction (Cranford, 2013; McFadden & Sims, 2017). Consequently, NNEs are unable to efficiently impart professional nursing knowledge to student nurses in the classroom (Summers, 2017). The current study explored NNEs' perspectives on easing the transition from nurse clinician to nurse educator in the Ghanaian context.

2 BACKGROUND

The transition of experienced nurse clinicians to the NNE role is receiving global attention as HTIs continue to rely on these nurse clinicians to take up faculty roles (Hoeksel et al., 2019). However, transitional support programmes and interventions are mostly in the developed countries (Nowell et al., 2017; Shieh & Cullen, 2019) with little emphasis placed on interventions required to ease the transition in Africa (Seekoe, 2016; Sodidi & Jardien-Baboo, 2020). In the Ghanaian context, the situation is no different and often results in difficult and stressful transitions (Laari, Apiribu, Gazari, et al., 2021). The absence thereof and inadequate transition support programmes also deepen the challenge of suboptimal teaching competencies in this novice population of nurse educators (Heydari et al., 2015).

International studies on easing the transition in high-income countries other than Africa have proven that transition support programmes play a major role in easing the transition of nurses from the clinician to the educator role (Dunker & Manning, 2018; Hinderer et al., 2016; Lynch et al., 2017; Ross & Silver Dunker, 2019). The findings of an integrative literature review on easing the transition from clinician to nurse educator revealed that formal preparation for teaching, guidance navigating the academic culture and a structured mentoring programme were key interventions that contributed to easing the transition (Grassley & Lambe, 2015). Whereas those studies did not focus on developing and implementing faculty transition interventions, the findings of other researches have underscored the urgent need to develop and implement faculty development, orientation and mentorship programmes aimed at easing the transition (Flanigan, 2016; Martin & Douglas, 2018; Owens, 2018; Shieh & Cullen, 2019).

A successful transition is imperative and beneficial to both faculty and students as novice faculty can offer the best assistance to students when they transition to academia with ease (Nelson et al., 2016). Therefore, nurse educators must be supported to attain optimal proficiency in assisting student nurses to acquire all the knowledge, skills, and attitudes necessary to practise nursing effectively in the 21st century (World Health Organization, 2016). In line with this, the World Health Organisation (WHO) spells out the core competencies required to be a nurse educator including; satisfactorily completing a recognized nursing education programme and acquiring formal teaching preparation either before, or immediately after recruitment (World Health Organization, 2016). Again, the WHO specifies that the core academic faculty in diploma and degree accredited HTIs are nurses and midwives who demonstrate pedagogical knowledge as educators and have preferably a minimum of graduate degrees (World Health Organization, 2009).

Most nurses and midwives in Ghana are trained in HTIs commonly called Nursing and Midwifery Training Colleges (NMTCs) and are usually but not necessarily affiliated with hospitals (Bell et al., 2013). As of 2018, Ghana had a total of 118 HTIs which offer certificate, diploma, and post-basic diploma in various nursing programmes (Nursing and Midwifery Council of Ghana, 2018). Currently, baccalaureate nursing programmes are offered in public and private universities with only three universities offering master's degrees in nursing, and none offering PhD. Unlike lecturers in the universities who usually have doctoral degrees, the nurse educators in HTIs usually have first degrees and previously practised as nurse clinicians in the clinical setting. Nurse educators in Ghana play multiple roles in both clinical and academic settings. They facilitate learning in both the classroom and during clinical sessions, facilitate learner development and socialization, participate in curriculum planning, evaluate programme outcomes and function as role models to students.

In Ghana, nurse educators are usually recruited from the clinical setting and posted to HTIs to teach (Laari, Apiribu, Amooba, et al., 2021). However, the absence of transition support programmes coupled with failure to meet the WHO requirements for nurse educators makes the transition more difficult (Laari, Apiribu, Gazari, et al., 2021). Hence, it is imperative to explore NNEs' perspectives on easing the transition from nurse clinician to nurse educator in Ghana. This paper reports part of a larger qualitative study which explored the transitional experiences of NNEs in Ghana. The findings will inform policy change and help in the development and implementation of a transition support programme that is well-designed and useful to meet the needs of NNEs within the Ghanaian setting. Thus, the research question was: What are the perspectives of NNEs on easing the transition from nurse clinician to nurse educator in Ghana?

3 METHODS

4 RESULTS

In all, 12 NNEs were purposefully selected and interviewed from these three HTIs. Five of them were chosen from college A, four from college B and three from college C. They were ten males and two females, their ages ranged from 32 to 39 years (average: 34.4 years), and they were all (n = 12) married. Nine participants had a bachelor's degree in nursing, two had a bachelor's degree in public health, one had a bachelor's degree in midwifery, and no participant had a formal education in teaching methodology. The NNEs had previously worked as nurse clinicians for a minimum of six years and a maximum of ten years (average: 7.25 years) before moving into academia and had an average of 1.75 years (range 1–2 years) of teaching experience as seen in Table 1.

Four main themes emerged from the analysis of the qualitative data which explored NNEs' perspectives on easing the transition from nurse clinician to nurse educator. These themes were as follows: mentoring, orientation to the educator role, pedagogical preparation, and postgraduate studies. Table 2 presents the main themes and their corresponding sub-themes.

5 DISCUSSION

As expert nurse clinicians transition into the NNE role, they are expected to benefit from transitional intervention programmes to make the transition process easier and successful (Grassley & Lambe, 2015). This current study aimed at exploring NNEs' perspectives on easing the transition from nurse clinician to nurse educator at three selected Ghanaian HTIs.

From the perspective of the sampled NNEs in this study, mentoring is necessary to ease the transition from nurse clinician to nurse educator. They opined that having access to experienced mentors and assigning NNEs to experienced educators within the training institutions for a substantial period would help novices to learn the educator role and become expert educators thereby easing the transition. This finding corroborates that of an integrative review of studies that overwhelmingly reported the need for mentoring during the transition from a nurse clinician role to an educator role (Fritz, 2018). Earlier studies have also shown that having access to experienced mentors has a positive influence in easing the transition because by pairing with experienced faculty members (mentors), the novices can develop competence and experience positive transitions (Cooley & De Gagne, 2016; Miner, 2019). However, in Ghana, especially in our study setting, most nurse clinicians who transition from practice to academia are usually left on their own to teach with no mentorship support which deepens the stress during the transition period. Based on this, we recommend that administrators of HTIs should identify experienced mentors within their institutions and assign newly posted nurse educators to them to be mentored before they assume full educator roles. By pairing with experienced mentors, NNEs can efficiently learn the educator role and easy acclimatize to the academic setting.

The development of individual mentoring programmes was predominantly mentioned by the participating NNEs as a way of easing the transition. The development and implementation of mentoring programmes have been proven as an effective way of easing the transition (Lynch et al., 2017; Nowell et al., 2015). Consistent with previous literature (Kalensky & Hande, 2017) the NNEs in the current study specified that mentoring programmes should be individualized to meet the specific needs of each novice. It is worth noting that mentorship programmes have been successfully developed and implemented in some developed countries including the United States of America (USA) (Hinderer et al., 2016; Lynch et al., 2017; Martin & Douglas, 2018), Australia (Slatyer & Kimberley, 2017), and South Africa (Seekoe, 2014) to help in easing the transition. However, these mentorship programmes are non-existent in low- and middle-income countries (LMICs) including Ghana. Therefore, we recommend the development and implementation of formal individual mentoring programmes based on current best evidence to help ease the transition from nurse clinician to nurse educator.

The NNEs in the current study reported the need for newly recruited nurse educators to be properly orientated to the nurse educator role before they commence full teaching roles. According to Marfell et al. (2017), orientation is an educative experience intended to support NNEs to begin their new roles, usually in a formal workshop format. Earlier studies have reported that orientating NNEs before they begin teaching is vital to easing the transition (Dempsey, 2007; Gilbert & Womack, 2012; Mann & De Gagne, 2017; Mower, 2017). Participating NNEs also recommended the development and implementation of college-specific orientation programmes tailored at easing the transition. Developing and implementing current faculty orientation programmes can assist new faculty in transitioning from their role as clinicians to educators (Nelson et al., 2016). Albeit some faculty orientation programmes have been developed and implemented to ease the transition in advanced countries such as the USA (Brown, 2015), such programmes are non-existent in LMICs, especially in Ghana. In developing an orientation program for new nursing faculty, their unique needs must be considered (Ross & Silver Dunker, 2019). Hence, we recommend the creation and continuous implementation of faculty orientation programmes that address the specific needs of individual colleges to include components such as curriculum development, lesson planning, teaching methods, test-item construction, student assessment methods and management of students' issues, among others.

From the perspective of the participating NNEs, pedagogical preparation is essential to easing the transition from nurse clinician to nurse educator. They indicated that obtaining a Post Graduate Diploma in Education (PGDE) should be a prerequisite for recruiting new nurse educators. They articulated that new nurse educators should enrol for PGDE before or immediately after being recruited and posted to the HTIs. They believed that enrolling for a PGDE would enable novices to gain insight into how to handle a class, classroom control, basic teaching methodology and how to manage difficult students. As pointed out by earlier studies (Booth et al., 2016; Flanigan, 2016; Owens, 2018) obtaining pedagogical preparation is critical to easing the transition and aids the development of instructor skills. The results of some integrative reviews have also overwhelmingly endorsed obtaining pedagogical preparation to ease the transition (Fritz, 2018; Grassley & Lambe, 2015). In the developed countries such as the United Kingdom and Australia, the primary criteria for teaching in nursing schools include the attainment of a teaching diploma (Jackson et al., 2011). The WHO Nurse Educator Core Competencies also stipulates that NNEs acquire formal teaching preparation either before or soon after recruitment (World Health Organization, 2016). Yet, in Ghana, most NNEs who teach in the HTIs still fall short of this requirement.

In Ghana, the PGDE is a diploma programme designed to equip personnel from all fields with the basic concepts of teaching and learning. Even though the PGDE is not designed specifically for nurse educators, it enhances the capacity of nurse educators to be more productive in teaching. Therefore, Ghana's Ministry of Health (MOH) through the health training institution secretariat should review the policy on nurse educator recruitment to ensure that only nurse clinicians with formal pedagogical preparation are recruited as educators. Existing nurse educators without formal training in pedagogy ought to enrol for a PGDE. We also recommend the creation of a nurse educator preparation and faculty development programme to be implemented for all the NNEs before they commence full teaching roles.

The sampled NNEs in the current study underscored the importance of a postgraduate degree in easing the transition from nurse clinician to nurse educator. To ease the transition, participants indicated that a master's degree is made the minimum academic requirement for educators and urged novices to enrol for a master's degree soon after employment. This finding concurs with earlier studies that have recommended obtaining graduate-level education to ease the transition (Pegg, 2018; Tucker, 2016). The findings of some reviews also endorsed that at minimum, nurse educators should hold a master's degree in nursing (Dipo et al., 2013) or even PhDs (Bullin, 2018). This perspective of our study participants also reaffirms the WHO's requirement that the core academic faculty are nurses and midwives who demonstrate knowledge as educators and have preferably a minimum of a postgraduate degree (World Health Organization, 2009). Nonetheless, in the Ghanaian context, recruited NNEs usually have bachelor's degrees and lack postgraduate qualifications.

In Ghana, a minimum of a postgraduate degree, especially a research master's degree is well designed to prepare nurses for academia. Unlike the PGDE which focuses on teaching and learning methods, the master's degree programme prepares the nurse educator in other facets of the faculty role including research. Therefore, we recommend a review of the policy on nurse educator recruitment in Ghana to consider only nurses with at least master's degrees for faculty positions. We also recommend that existing nurse educators without postgraduate degrees be as a matter of urgency, directed to enrol for a master's degree.

The findings of the current study are relevant to nursing education in Ghana. These recommendations, when implemented, will not only ease the transition process but will also lead to the attraction and retention of more competent nurse educators in Ghana. This will significantly improve the quality of nurses trained in Ghana.

6 STRENGTHS AND LIMITATIONS

The recruitment of NNEs from three HTIs (space triangulation) permitted the exploration of the subject across the region and contributed to the strengths of the study. A limitation was that the study only explored the perspectives of NNEs and did not include college administrators and principals whose perspectives could have added more value to the study. Also, the involvement of only two female participants and one midwifery participant was a limitation since the inclusion of more female and midwifery participants could generate novel findings.

7 CONCLUSION

The current study highlighted the development and implementation of individual mentoring programmes and college-specific orientation programmes as essential to easing the transition from nurse clinician to nurse educator. Pedagogical preparation and acquisition of postgraduate degrees are also essential to easing the transition from nurse clinician to nurse educator. The findings of this study serve as a groundwork for future development and implementation of a transition support programme to ease the transition from nurse clinician to nurse educator in Ghana.

AUTHOR CONTRIBUTIONS

Timothy Tienbia Laari: Conceptualized and designed the study, collected and analysed data, and drafted the manuscript. Felix Apiribu: Contributed to the study design, assisted with data analysis and critically revised the final manuscript. Veronica Millicent Dzomeku and Adwoa Bemah Boamah Mensah: Contributed to the study design, reviewed and revised the final manuscript. Philemon Adoliwine Amooba: Contributed to reviewing and revising the manuscript. All the authors read the final manuscript and gave approval for publication.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.