Nurse Education Today (2007) xxx, xxx–xxx

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EducationToday

Substantive theory on commitment to nurseteacherhood

Arja Holopainen a,b,*, Kerttu Tossavainen a, Eija Karna-Lin c

a Department of Nursing Science, University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finlandb North Karelia University of Applied Sciences, Tikkarinne 9, 80200 Joensuu, Finlandc Department of Special Education, University of Joensuu, P.O. Box 111, 80101 Joensuu, Finland

Accepted 31 July 2007

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KEYWORDSNurse teacher;Grounded theory;Commitment tonurse teacherhood

60-6917/$ - see front mattei:10.1016/j.nedt.2007.07.0

* Corresponding author. Addplied Sciences, Tikkarinne58 50 5508303; fax: +358 13E-mail addresses: arja.horttu.tossavainen@uku.fi (Kensuu.fi (E. Karna-Lin).

Please cite this article in prEduc. Today (2007), doi:1

r �c 20011

ress: No9, 80200260660

lopainen. Tossa

ess as: H0.1016/

Summary Nurse teacherhood is usually examined from the perspectives of nurseteachers’ tasks, roles, skills and managing. The purpose of this study was to discusshow nurse teachers themselves describe their teacherhood. The purpose was also togenerate a substantive theory of nurse teacherhood, its development, changes andmanifestation. Nurse teachers from different polytechnics (today called universitiesof applied sciences) in Finland (N = 34) were interviewed using a semi-structuredinterview. The data were analysed by employing the grounded theory method.Nurse teacherhood was found to be a dynamic process influenced by processes ofchange in the organisation, the operating culture of the health care working com-munity, nurse teachers’ professional self-esteem, the focus of nurse teachers’ com-petence, their relationship with students, the future of their profession andrequirements for staying in the profession. Commitment emerged as the core fea-ture of nurse teacherhood. It was possible to distinguish eight types of commitment:(1) searching for new content in one’s position, (2) being adapted to one’s position,(3) trying to advance in one’s position, (4) having found one’s position, (5) searchingfor one’s position, (6) withdrawing from one’s position, (7) being satisfied withone’s position and (8) being uncertain about one’s position.

�c 2007 Elsevier Ltd. All rights reserved.

7 Elsevier Ltd. All rights rese

rth Karelia University ofJoensuu, Finland. Tel.:

1.@ncp.fi (A. Holopainen),vainen), eija.karna-lin@

olopainen, A. et al., Substaj.nedt.2007.07.011

Introduction

The development of nurse education and changestaking place in society and healthcare also influ-ence nurse teacherhood. Nurse teacherhood andrelated challenges have been studied from severaldifferent perspectives. Research interests have in-cluded, among other things, nurse teachers’ tasks

rved.

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and role in performing different tasks (e.g. Clif-ford, 1995; Duffy and Watson, 2001), skills andcompetence (e.g. Scollin, 2001; Hardicre, 2003),qualities of a good teacher (e.g. Morris, 1995; Be-nor and Leviyof, 1997) and managing and job satis-faction (e.g. Stamnes, 2000; Gormley, 2003).Previous studies indicate that the demands concen-trated on the competence and actions of nurseteachers are complex and increasingly challenging,because changes in the job description and operat-ing environment of nurse teachers now requiremore skills besides those connected to teachingand student supervision (e.g. doing research, pub-lications, co-operation with practise).

Background

There are several factors that influence nurseteacherhood (e.g. tasks, patterns of practise inthe working community), and some researchershave concluded that they are culture-specific, atleast to a certain extent. For instance, the valuesprevailing in each society are visible in nurse teach-erhood, and nurse teachers’ working culture is dif-ferent in each country (e.g. Stamnes et al., 1998;Luukkainen, 2004). Similarly, teacherhood hasbeen regarded as a part of each teacher’s personal-ity, and thus there are also individual differencesbetween teachers (e.g. Morris, 1995; Gilmartin,2001). Nurse teacherhood is altered by, amongother things, changes in society, and especially inhealthcare education, the healthcare service sys-tem, development of different disciplines (e.g.nursing science, medicine, pedagogy) and the tea-cher’s individual growth and personal develop-ment. Facing changes is not easy, and eachteacher has a different way of reacting to them(Stamnes, 2000; Reece et al., 2003). The changescan be experienced as either stressful or a possibil-ity to develop one’s own work and competence.Support received from the organisation, leadersor other colleagues and work-related resources allhave an influence on how nurse teachers cope withchanges and manage in their work (e.g. Camiah,1997; Harri, 1997).

The actions of nurse teachers and challenges totheir competence have been studied extensively.Research results indicate that the tasks and jobdescription of nurse teachers have changed duringthe last 10 years. In addition to traditional teachingtasks, a nurse teacher’s job description includes,for example, research and development activities,maintaining contact with several co-operationpartners (e.g. nursing practise) and differentadministrative and office duties (e.g. Aston et al.,

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

2000; Hardicre, 2003). This article discusses thecategories that, according to nurse teachers them-selves, form nurse teacherhood. Nurse teachersgave individual meanings to the categories that de-scribe their own nurse teacherhood, although indi-vidual experiences of teacherhood were formed ininteraction with other people (e.g. colleagues).The article also explores how nurse teachers’ indi-vidual interpretations of their current and futureprofessional situation alter their individual experi-ences of teacherhood and finally influence nurseteachers’ commitment to teacherhood. The aimof the study is to develop a substantive theorydescribing nurse teacherhood, its development,changes and manifestation. The research tasksare: 1. How do nurse teachers describe their over-all teacherhood? 2. How is nurse teacherhoodmanifested? 3. What is the substantive theorydescribing nurse teacherhood?

Methods

Participants and data collection

The data were gathered in 2003 and 2004 by con-ducting semi-structured interviews in eight unitsof five polytechnics offering nurse education.Nurse teachers willing to participate in the study(N = 34) were interviewed. The interview themesdealt with being a nurse teacher, the meaning ofteacherhood to nurse teachers, the significance ofthe working community to them and their own con-ceptions of what it will be like to be a nurse tea-cher in the future.

The interviewed nurse teachers were teachersof vocational subjects in nurse training, publichealth nurse training and/or midwife training.The interviewees had from 2 to 20 years of workexperience in nursing practise (8.5 years on aver-age) and had worked as nurse teachers for between1 and 30 years (14 years on average). A total of 23interviewees had a Master’s degree, five heldeither a licentiate or doctoral degree and six hada Bachelor’s degree.

Data analysis

The methodological approach of the study wassymbolic interactionism (Blumer, 1969, 1978; Ben-zies and Allen, 2001). The data were analysed byusing the grounded theory method according tothe approach by Strauss and Corbin (1990, 1998).The analysis employed open, axial and selectivecoding to identify central concepts emerging from

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the data, recognise connections between them andidentify core categories (Strauss and Corbin, 1990,1998). Open coding included a precise specificationof the data and formatting of preliminary conceptsand classifications. Content-related, i.e. substan-tive codes were formed from the original expres-sions, which enabled gradual identification ofsubcategories and upper categories that emergedfrom the data (see Strauss, 1993; Strauss and Cor-bin, 1998; McCann and Clark, 2003a,b).

Specification of the categories was continuedusing axial coding. The analysis proceeded on anabstract level by comparing the subcategories,combining associated subcategories into uppercategories and then combining these into maincategories. Connections between categories weresought by means of selective coding, and a corecategory that combines the categories from the

Change process in the organisation: +/-

Operating culture of the health care

working community: +

Relationship with students: +/-

Utilising one’s own speciality: +

Basic task of teacher: +

Future: +

A11): Searching

for new contents

in one's

position

A21): Being

adapted to

one's position Core cateCommitm

to nurse

C11): Searching teacherh

for one's

position

C21): With-

drawing from

one's position

Future: -/+

Basic task of teacher: -

Utilising one’s own speciality: -

Relationship with students: +/-

Operating culture of the health care

working community: -

Change process in the organisation: -

1) A1-D2: Commitment types to nurse teacherhood

Icons: + strong satisfaction; +/- moderate satisfaction; -/+ m

Ope

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ealth

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Figure 1 Multidimensional categories’ dynamic conn

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

point of view of the studied phenomenon wasidentified. The core category connecting all othercategories and describing the experience of nurseteacherhood was Commitment to nurse teacher-hood. It describes the process where nurse teach-ers experience their own teacherhood and itscontent, its meaning to themselves and the direc-tion towards which their teacherhood is likely todevelop. A conditional matrix was used to assistthe analysis and examine the categories’ rela-tions, their internal dimensions and reciprocalmovements (see Strauss and Corbin, 1990, 1998;Strauss, 1993). The conditional matrix also helpedidentify the multidimensional categories’ dynamicconnection to the core category. The main cate-gories closest to the core category influenced itthe most. Furthermore, the conditional matrixshowed up in two main categories (nurse teach-

Change process in the organisation: +/-

Operating culture of the health care

working community: +/-

Relationship with students: +

Utilising comprehensiveness:+

Basic task of teacher: +

Future: -/+

B11): Trying

to get forward

from one's

position

B21): Having

found one's

gory: positionent

ood D11): Being

satisfied

with one's

position

D21): Being

uncertain about

one's position

Future: -

Basic task of teacher: -

Utilising comprehensiveness: -/+

Relationship with students: +/-

Operating culture of the health care

working community: -/+

Change process in the organisation: -

oderate dissatisfaction; - strong dissatisfaction.

working com

munity: +

Operating culture of the health care

Change process in the organisation: +

/- C

hange process in the organisation: +/-

Operating culture of the health care

working com

munity: +

Utilising com

prehensiveness: +

Basic task of teacher: +

Utilising com

prehensiveness: +

Relationship w

ith students: +

Basic task of teacher: -

Relationship w

ith students: +

Future: +

/-F

uture: +/-

ection to the core category in conditional matrix.

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ers’ professional self-esteem and the focus ofnurse teachers’ competence) with properties(Teacher’s basic task in the main category Nurseteachers’ professional self-esteem and Utilisingone’s own speciality or comprehensiveness inthe main category Focus of nurse teachers’ com-petence) that significantly influenced the corecategory. This is why these properties represent

Organisation7)

Working community6)

Students5)

Speciality4)

Basic task3)

Future2)

A11):

Searching for Tr

new contents fo

in one's on

A21): Being position po

adapted to

one's position Commitmto nurse

C11): teacherh

Searching

for one's

position

C21):

Withdrawing B

from one's position ab

Future2)

Basic task3)

Speciality4)

Students5)

Working community6)

Organisation7)

Icons of arrows:

strengthens strongly; strengthens slightly; dec

2) changes inside the category cause the mo

1) A1-D2: Commitment types to nurse teacherhood2) Future (includes both Future in one’s profession and

6) Working community = Operating culture of the health 7) Organisation = Process of change in the organisation

Comprehensiveness = Utilising comprehensive skills (5) Students = Nurse teachers' relationship with students

3) Basic task = Basic task of teacher (Nurse teachers' pr4) Speciality = Utilising one’s own expertise (Focus of nu

1) connection to commitment type:

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3)

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Figure 2 Substantive theory describing

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

the main categories (Nurse teachers’ professionalself-esteem and Focus of nurse teachers’ compe-tence) in Figs. 1 and 2. Commitment to teacher-hood was manifested as eight different types ofcommitment (Fig. 1). These types of commitmentdescribed nurse teachers’ orientation to nurseteacherhood. The orientation process was verydynamic due to changes in categories and mean-

Organisation7)

Working community6)

Students5)

Comprehensiveness4)

Basic task3)

Future2)

ying to get

rward from

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sition B21):

Having found

ent one's position

ood D11): Being

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eing uncertain

out one's position

Future2)

Basic task3)

Comprehensiveness4)

Students5)

Working community6)

Organisation7)

reases slightly; decreases strongly

vement between commitment types

Requirements for staying in the profession)

care working community

Focus of nurse teachers’ competence)

ofessional self-esteem)

rse teachers’ competence) or

Students

5)

Working com

munity 6)

Organisation

7)

Students

5)

Working com

munity

6)

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Future

2)

Basic task

3)

Future

2)

Basic task

3)

Com

prehensiveness4)

Com

prehensiveness4)

11):

21):

commitment to nurse teacherhood.

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ings nurse teachers gave to the categories ininteraction with other people. As teachers gavedifferent meanings to the categories, their orien-tation and commitment to nurse teacherhoodchanged. Individual experiences connected tothe dimensions of the categories explained thecategories’ individual meanings and their relation-ships with each other in different types of com-mitment. The degree of satisfaction varied. Thecategories were given meanings (see Fig. 1)describing strong satisfaction (+), moderate satis-faction (+/�), moderate dissatisfaction (�/+) andstrong dissatisfaction (�). Satisfaction strength-ened and dissatisfaction weakened commitmentto nurse teacherhood.

Results

The substantive theory developed in this study con-tains categories and their inter-relationshipsdescribing nurse teacherhood and a core categorydescribing the basic process of that interaction,and finally, its manifestation as types of commit-ment to nurse teacherhood (Fig. 2).

Commitment to nurse teacherhood (Fig. 2) wasconnected to the context of nurse teacherhood(Process of change in the organisation, Operatingculture of the health care working community),content of the profession (Nurse teachers’ profes-sional self-esteem, Focus of nurse teachers’ com-petence, Nurse teachers’ relationship withstudents) and the future (Future in one’s profes-sion, Requirements for staying in the profession).The above-mentioned categories were in constantinteraction with each other, and thus changes inthem influenced the way nurse teachers experi-enced teacherhood and its development. The con-tents of the categories are described in more detailin another article (see Holopainen et al., submittedfor publication).

Commitment to nurse teacherhood (Fig. 2) wasa dynamic, individual process that was constantlychanging over time. Nurse teachers’ individualexperiences concerning the significance of the con-text, content and future of nurse teacherhood hadan impact on how strongly or weakly they werecommitted to nurse teacherhood. The relationshipwas reciprocal.

Commitment to nurse teacherhood, its strengthor weakness, together with the process of changein the organisation, the operating culture of thehealth care working community, nurse teachers’professional self-esteem (especially with regardto the basic tasks of a teacher), the focus of nurseteachers’ competence (especially whether empha-

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

sising one’s special expertise or comprehensiveskills), nurse teachers’ relationship with students,the future (including the future in one’s professionand requirements for staying in the profession) andchanges occurring in the above-mentioned catego-ries explained the types of commitment (Fig. 2) tonurse teacherhood and their dynamics. The follow-ing eight types of commitment describing orienta-tion to nurse teacherhood were identified: (1)searching for new content in one’s career position(A1), (2) having adapted to one’s position (A2), (3)wishing to advance in one’s position (B1), (4) hav-ing found one’s position (B2), (5) searching forone’s position (C1), (6) withdrawing from one’s po-sition (C2), (7) being satisfied with one’s position(D1) and (8) being uncertain about one’s position(D2).

Commitment types A1 and A2 were identified asmoderately satisfied. For teachers representingthese two commitment types, the teacher’s basictask in the polytechnic was sufficiently clear andthey emphasised their own field of speciality asformer nurses in their substance competence.Nurse teachers searching for new content in theirwork in the current position (A1) were mainly sat-isfied with changes in their tasks and the possibili-ties of utilising their competence in their currentwork. They were not completely satisfied withadministrative changes within the organisation(e.g. changes in the organisational structures),but felt that changes in the content of the organi-sation (e.g. development of tasks transferred topolytechnics) were heading in the right direction.They expected to work at the polytechnic also inthe future, but hoped for new and possibly morechallenging tasks: ‘‘. . .I think a polytechnic teacherdoing research would be the kind who would devel-op things by studying and would in that sense bemultiprofessional and also multidisciplinary’’(H2.27).

Nurse teachers who were adapted to their posi-tion (A2) considered their present tasks meaningfuland wanted to continue with them also in the fu-ture. However, they differed from the teacherssearching for new content in their work in theirpresent position by considering that nurse teach-ers’ task was to teach practical skills needed innursing while teachers in commitment type A1were of the opinion that nurse teachers’ task wasto teach how to care for people on a more generallevel than that of concrete skills. Nurse teacherswho were adapted to their position had a positiveattitude towards their own future because theyconsidered the current tasks as meaningful andtheir employment seemed secured: ‘‘. . .there willalways be changes and there should be. They also

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keep spirits high, I don’t see them as a threat and Idon’t think my job is in danger’’ (H2.25).

Teachers in commitment types B1 and B2 consid-ered themselves to be mainly satisfied with theirwork, and the basic task of a polytechnic nurse tea-cher was clear enough to them. In their substancecompetence they emphasised the importance ofcomprehensive competence. Nurse teachers tryingto advance in their position (B1) thought the poly-technic had opened up new possibilities for teach-ers to operate also in other tasks of nurse teachersbesides traditional ones. On the other hand, theywere also prepared to find work elsewhere if thenew tasks would be interesting and meaningful.They were not as satisfied with the operating cul-ture of the health care working community as wereteachers in commitment types A1 and A2, becausethey felt the atmosphere of the working commu-nity was not good enough due to different viewsand opinions. These teachers were mainly satisfiedwith the process of change in the organisation,although they were dissatisfied with administrativechanges within the polytechnic. They felt the orga-nisation of the polytechnic had become increas-ingly hierarchical owing to too much power beingconcentrated on the management while theemployees’ possibilities of influencing had de-creased. They were, however, mainly confident inthe future and trusted their own competence,assuming that they could, if they so wished, alsofind work elsewhere (e.g. in different projects):‘‘. . .teachers’ working hours aren’t necessarily inthat organisation anymore . . .the teacher is adeveloper, who has a wider perspective tothings . . . I think I’ve been able to do more of suchthings and managed to bring out my own compe-tence and then I‘ve used it’’ (H2.15).

Nurse teachers who had found their position (B2)had discovered meaningful tasks at the polytechnicand thus wanted to work there also in the future.They differed from teachers in the previous commit-ment type (B1) most explicitly in that they weremore satisfied with the functioning of their ownworking community. They were also primarily satis-fied with the direction of changes in the organisa-tion, and the demands concentrated on teacherswere not too excessive for them. They would liketo work at the polytechnic also in the future becausethe development of the educational institution hadmade the work of a nurse teacher more meaningfulto them: ‘‘. . .the principal of my former job (fromsecondary education) told me maybe two weeksago . . .that they have a few posts coming up . . .thataren’t you at all interested in applying. So, I justsaid that’s nice to hear and all that, but for heaven’ssake I never thought about going there’’ (H2.12).

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

Unlike their colleagues in the previous types ofcommitment, teachers in commitment types C1and C2 considered themselves mainly dissatisfiedwith their work because they thought, for instance,that nurse teachers’ basic task in the polytechnicwas either unclear or becoming obscured. Similarto teachers in commitment types A1 and A2, teach-ers in commitment types C1 and C2 emphasisedtheir own field of speciality, previously acquiredthrough studies and work, in their substance com-petence. Nurse teachers searching for their posi-tion (C1) were dissatisfied with the changes intheir tasks (e.g. increase in research activities),because task management and utilisation of theirown competence had previously been easier andhad felt more meaningful than they did at present.Furthermore, the teachers were dissatisfied withtheir possibilities of affecting the content of theirown work. They were mainly dissatisfied with theoperating culture of the health care working com-munity because it was hard to influence. However,they were primarily satisfied with the support ofthe working community and especially the supportreceived from their closest colleagues. Teachers incommitment type C1 were not satisfied with theadministrative and content-related changes of thepolytechnic, because the organisation had becomebureaucratic (e.g. changes proceeded slowly with-in the organisation), and wrong aspects wereemphasised when developing the content of func-tions. Despite their discontentment and the feelingof not yet having found their place, they neverthe-less wanted to continue as nurse teachers at thepolytechnic: ‘‘. . .to me this teacher’s identityhasn’t yet become very strong . . . I don’t want togive up being a nurse . . .the ideal would be thekind of teacher who would be sort of a clinical tea-cher’’ (H2.19).

Nurse teachers withdrawing from their position(C2) were also dissatisfied with their work andchanges occurring in the polytechnic. These teach-ers were even unhappier with the atmosphere oftheir health care working community and the sup-port received from colleagues than were the teach-ers in the previous type of commitment (C1). Theywere also dissatisfied with the changes in the orga-nisation, particularly because when developingtheir functions, the polytechnics concentrated onexternal matters (e.g. increasing the number ofinternational co-operation partners), while devel-opment of the content of the functions (e.g. devel-oping educational content and methods) did notreceive enough attention. Informants in this typeof commitment would not wish to continue asnurse teachers in the polytechnic unless therewas a distinct change in the content of the work

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and the working community: ‘‘I wonder whetherI’m really in the right place . . .that I’ve alreadyearlier shifted from being a teacher into nursingpractise . . . so I’m not at all sure whether I’ll bein this position five years from now’’ (H2.30).

Teachers in commitment types D1 and D2 con-sidered themselves mainly dissatisfied with theirwork. In their opinion, also, the basic task of anurse teacher in the polytechnic was unclear orgetting obscure. Like teachers in commitmenttypes B1 and B2, these teachers emphasised thecomprehensiveness of nursing in their substancecompetence. Nurse teachers satisfied with theirposition (D1) were quite satisfied with their work-related changes, while they remained mainly dis-satisfied with all the other aspects of their work.Changes in their tasks were considered both suc-cessful and unsuccessful. Teachers in this type ofcommitment were satisfied with the operating cul-ture, atmosphere and support of their workingcommunity. It was possible for individual teachersto sufficiently influence the decision-making ofthe working community, their own work and itscontent. Despite the deficiencies in their work,they considered it likely that they would continuein their present tasks also in the future, becausethere was something good to be found in the workas well: ‘‘. . . I realise, that the more I learn aboutmyself, recognise things and know myself, the eas-ier it is to operate in this kind of social network,and it’s also easier to work in this teacher commu-nity’’ (H2.11).

Nurse teachers who were uncertain about theirposition (D2) were primarily dissatisfied with theirwork and changes connected to the developmentof the polytechnic. These teachers were more dis-contented with the atmosphere of the health careworking community and support from the workingcommunity than were teachers in the previouscommitment type (D1). Furthermore, they weremore dissatisfied with the established patterns ofpractise in the working community, their possibilityof influencing the decision-making of the workingcommunity and the administrative and content-re-lated changes than were the nurse teachers whowere satisfied with their position (D1). The changesconnected to teachers’ work and excessive de-mands concentrated on teachers were the reasonsthey were not certain whether or not they wouldcontinue with the same tasks also in the future.They felt that finding a new job at another poly-technic or other educational institution in the samefield could be a future alternative: ‘‘. . .of courseI’m happy that I’ve obtained this formal qualifica-tion . . . ,if it’s someday questioned, then I’m readyto apply for some other work’’ (H2.2).

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All eight types of commitment were dynamicand they described nurse teacher’s individual ori-entation to nurse teacherhood. The movementdescribing the change was fast within and betweensome types of commitment, whereas in others itwas slow. Commitment to nurse teacherhood wasstrongest among teachers who had found their po-sition (B2) and those who were adapted to their po-sition (A2). Furthermore, teachers searching fornew content in their present work (A1) and thosewho were satisfied with their position (D1) weremainly content with their profession, although theywere ready for changes in their current tasks.Teachers who were trying to advance in their posi-tion (B1) were satisfied at the moment, but wereready to move on in their career, feeling that theircompetence was not used to the full in their cur-rent tasks. Teachers searching for their position(C1) were those whose commitment to nurseteacherhood was fairly good but clearly changingat the time of the study. As far as these teachersare concerned, changes influencing nurse teacher-hood or the opening of new interesting tasks out-side the polytechnic might easily lead them toabandon their current tasks. Teachers withdrawingfrom their position (C2) and those who were uncer-tain about their position (D2) had the weakest com-mitment to teacherhood, and would probably bethe first to take up new tasks elsewhere unlessthe factors influencing nurse teacherhood changedinto a direction that would satisfy them. In additionto clear changes in commitment to nurse teacher-hood being demonstrated in the teachers’ eitherstaying in the profession or heading away from it,they may also migrate between the types ofcommitment.

Discussion

The way nurse teachers experience the changesthat have occurred over time influences their levelof satisfaction with their own nurse teacherhoodand their commitment to it. Similarly, satisfactionwith the context, content and future of nurseteacherhood and migration between the types ofcommitment explained the level of nurse teachers’commitment to teacherhood at each point in time.Teachers’ conception about the future, the clarityof teachers’ basic tasks and possibilities of utilisingone’s own expertise or comprehensive skills eithersupported or prevented commitment to nurseteacherhood the most. Migration between the cat-egories best predicts how well or how poorly theteachers commit themselves to teacherhood. Forexample, if teachers who are satisfied with their

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position at the moment notice that in the futurethey will not be able to utilise their comprehensiveskills as before, they may migrate towards teachersthat are uncertain about their position. In addition,teachers’ relationships with the students, the oper-ating culture of the health care working commu-nity, the process of change in the organisationand changes in these either strengthen or weakenthis commitment.

Nurse teacherhood was a multidimensional anddynamic process and teachers had individual waysof experiencing it, although the meanings givento nurse teacherhood were constructed in interac-tion with other people. Thus, also teachers’ actionsand experiences of changes in their work and pro-fession were individual. Studies that discus nurseteacherhood by examining the tasks included in it(e.g. Cahill, 1997), the skills demanded of nurseteachers (e.g. Benor and Leviyof, 1997; Scollin,2001) and changes in the above help in understand-ing nurse teacherhood. However, this approach isproblematic if nurse teachers’ tasks and roles,the skills demanded of them and the changes con-nected to these are expected to be either equallymeaningful to all teachers or to be manifested intheir work in the same way. This would not accountfor differences between individual nurse teachers.

Ethical issues and limitations of the study

The research practises were based on generally ac-cepted ethical principles for scientific research.The rights and wishes of the interviewees were re-spected throughout the research, particularly theright of informed consent and refusal to take part.Proper written permission for the study was ob-tained from each polytechnic involved. Verbal in-formed consent was obtained from all theparticipants. The anonymity of the recipients wasconsidered when reporting the results. The datacollected from five different polytechnics (N = 34)were combined to prevent the reader from identi-fying which polytechnic each informant came from(e.g. Behi, 1995; Holloway and Wheeler, 2002).

With regard to the quality of the data, analysisand reporting of the results, the validity of thestudy was evaluated by means of criteria fromqualitative research: credibility, dependability,confirmability and transferability (Lincoln andGuba, 1985). The credibility of the study was in-creased by the fact that the interviewees describedthe studied phenomenon from various aspects. Theauthors referred back to the original data severaltimes during the analysis to ensure that the studywould correspond to the interviewees’ opinions

Please cite this article in press as: Holopainen, A. et al., SubstaEduc. Today (2007), doi:10.1016/j.nedt.2007.07.011

and experiences concerning nurse teacherhood asaccurately as possible. In addition to credibility,the purpose was to ensure the dependability ofthe analysis and results. Different phases of the re-search process have been described in the text toenable the reader to evaluate the confirmabilityof the research, i.e. whether the research processhas proceeded correctly and the drawn conclusionsare justified. To evaluate the transferability of theresults, the context in which the study was realised(Finnish nurse teachers in a polytechnic) is de-scribed in the text.

Conclusions

The substantive theory developed in this study de-scribes nurse teacherhood and commitment to it,its development, changes and manifestation asexperienced by nurse teachers. Teachers experi-ence not only their teacherhood, but also thechanges occurring in the context, content and fu-ture of nurse teacherhood individually, althoughthey gave meaning to their teacherhood in interac-tion with other people, e.g. colleagues. For some,the changes in the work and working communitystrengthened their commitment to nurse teacher-hood, while for others the same issues weakenedtheir commitment. It is likely for those teacherswho were adapted to their position, had foundtheir position or were satisfied with it to go mostunnoticed in the working community. The needs(e.g. possibilities of utilising their competence) ofthese teachers may easily be overlooked in theworking community, because they are expectedto adapt to changes without conflicts. A challengeof working communities and their leaders is toidentify the teachers whose commitment to nurseteacherhood is weak or weakening. These teacherswere those who were searching for their position,withdrawing from their position or uncertain abouttheir position. They need special support in theirwork in order for them not to become exhaustedor wish to find work elsewhere.

A further important issue is to identify teacherswho are searching for new challenges in their work.Such nurse teachers were those who were search-ing for new content in their work in the present po-sition and those who were trying to advance intheir position. Unless these teachers experiencetheir present work as meaningful enough, theymay search for new, more challenging tasks outsidethe polytechnic. Nurse teachers with a positiveattitude towards change and development wouldthen leave the working community.

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