Narratives from the Newly Appointed Deans of Selected Philippine Colleges of Nursing in Establishing Baccalaureate Nursing Program

Cyruz P. Tuppal1*, Mandy Roie A. Atendido2, Ana Blesilda C. Atendido2, Marina Magnolia G. Ninobla3

1College of Allied Health, Department of Nursing, National University, 1008 Manila, Philippines

2College of Nursing, Ilocos Sur Polytechnic State College-Main Campus, Candon City, 2710 Ilocos Sur, Philippines

3College of Nursing and Midwifery, Good Samaritan Colleges, Cabanatuan City, 3100 Nueva Ecija, Philippines

*Corresponding Author’s Email: drcyruz@gmail.com

ABSTRACT

Background: The healthcare landscape is in constant flux, driven by evolving patient needs, technological advancements, and shifting health policies. This demands a nursing workforce with critical thinking, adaptability, and specialised skills to manage complex patient cases effectively. However, the current supply of nursing graduates in the Philippines falls short of meeting the growing healthcare demands. Establishing more Bachelor of Science (BSc) Nursing programs is crucial to bridge this gap and ensure high-quality patient care. Expanding these programs will increase the number of qualified nurses, addressing staffing shortages and improving patient outcomes. Methods: This research used a narrative inquiry approach, focusing on ten recently appointed deans of nursing programs who were tasked with establishing BS Nursing programs at private colleges or universities in the Philippines. This ensured participants had firsthand experience with the challenges and complexities involved in program development. Thematic analysis was employed to identify key themes. Results: Thematic analysis revealed several complexities in establishing a BS Nursing program, including securing qualified faculty, obtaining accreditation, securing clinical placements, managing financial investments, attracting students, and balancing theory and practice. The need to keep the curriculum current, manage student expectations, and balance faculty and student needs also emerged as significant challenges. Despite these obstacles, the importance of establishing additional BS Nursing programs is evident in addressing the nursing shortage and ensuring quality care. Conclusion: This research offers valuable insights into the complexities of establishing BS Nursing programs, providing guidance for future program developers and policymakers in the Philippines.

Keywords: Bachelor of Science in Nursing; College of Nursing, Deans; Narrative Inquiry; Philippines

INTRODUCTION

The healthcare landscape is in constant flux, demanding a nursing workforce with the knowledge, skills, and critical thinking abilities (Saghafi et al., 2023; Thornhill-Miller et al., 2023). Recognising this need, the baccalaureate nursing programs serve as the entry point to the nursing profession, signifying a commitment to elevating the standards of nursing education and practice across the globe (Bryman, 2007; Nichols et al., 2024; Nutayi, 2024). The move towards a BSN-prepared workforce is not merely about aligning with international standards; it represents a commitment to equipping Filipino nurses with the advanced knowledge and skills necessary to thrive in increasingly complex healthcare settings (Maddock, 2023; See et al., 2023; Sterner, Eklund & Nilsson, 2023).

Recently appointed deans frequently encounter unfamiliar situations, as they are responsible for constructing programs from scratch or substantially extending current ones (Day, 2000; Lutaaya, Ronald, & Nakamanya, 2024; Mollman et al., 2024). They are confronted with the challenging responsibility of creating a curriculum, attracting and keeping skilled professors, arranging clinical opportunities, and providing the required infrastructure to maintain a top- notch learning environment. These issues are exacerbated by the specific circumstances of the Philippine educational system, which has limitations. Deans must manage the expectations of multiple stakeholders, such as students, faculty, accrediting organisations, and the broader healthcare community, each with their distinct objectives and viewpoints (Belita, Carter & Bryant-Lukosius, 2020; Bowen et al., 2024; Davis-Salazar, 2023).

Many nursing programs have been criticized for their outdated curricula, lack of hands-on training, and insufficient resources to adequately prepare students for the realities of the profession (Al-Worafi, 2024; Tseng et al., 2011; Vista et al., 2022). De Roeck (2023) opined that the Philippines' healthcare system is under immense pressure, with a growing population and an increasing demand for quality medical services. Establishing more BS Nursing Programs in the Philippines is crucial for addressing this skills gap and ensuring that the country's healthcare system is equipped with the necessary nursing workforce to provide high- quality patient care (Al-Worafi, 2024; Cabanes, Joaquin-Quino, & Salvacion, 2023; Ortiga, 2014; Sommers & Rio, 2023; Young & Roos, 2024). By offering a more comprehensive and rigorous nursing education, these programs can produce graduates who are better prepared to navigate the complexities of the modern healthcare landscape (Cabanes, Joaquin-Quino, & Salvacion, 2023; Ortiga, 2014).

The Philippine nursing education sector faces significant challenges in meeting the growing demand for qualified nurses. Deans, particularly those newly appointed, are critical in addressing these challenges by establishing and leading successful Baccalaureate Nursing Programs. This qualitative study explores the experiences of newly appointed deans leading recently established Bachelor of Science in Nursing (BSN) programs at Philippine colleges. Their stories offer valuable insights into the realities of launching a BSN program, providing a rich understanding of the successes, struggles, and key factors shaping Philippine nursing education. The study provides a timely perspective by focusing on the experiences of newly appointed Deans, a demographic rarely explored in existing literature (Bautista & Orte, 2021).

Despite the wealth of literature on nursing education in the Philippines, there is a significant gap in understanding the experiences and challenges faced by newly appointed deans of nursing colleges, particularly in establishing baccalaureate nursing programs. Existing studies predominantly focus on the broader landscape of nursing education, curriculum development, or student outcomes (Dowling & Melillo, 2015; Redmond, 1991). However, the unique perspectives and narratives of those tasked with leading and shaping these programs remain largely unexplored. This study aims to fill this void by delving into the lived experiences of newly appointed deans and uncovering the complexities, strategies, and decision-making processes involved in establishing and sustaining high-quality baccalaureate nursing programs in the Philippine context.

METHODOLOGY

Study Design: This study employed a narrative inquiry approach. According to Clandinin (2006), narrative inquiry is a qualitative research method that centers on individuals' stories and experiences. Figure 1 shows the simplified framework of narrative inquiry along with the process of content analysis that offered several advantages for this study: (1) Capturing complexity (Hendry, 2009). Opening a BS Nursing program is a multifaceted process with numerous challenges. Narrative inquiry allowed the Deans to recount their experiences in detail, capturing the nuances and complexities they encountered. (2) Understanding the "why" (Kim, 2015). Beyond simply identifying challenges, the Deans' stories could illuminate the underlying reasons behind those difficulties. (3) Building a shared understanding (Gill, 2001). The research could better understand the challenges faced when establishing BS Nursing programs by weaving together the deans' narratives. This shared understanding can prove invaluable for future program developers and policymakers in the Philippines. (4) Giving voice to experience (Middleton et al., 2024). Narrative inquiry empowers participants to share their unique perspectives. The Deans' voices become the driving force of the research, offering valuable insights that might not have been captured through other methods like surveys or focus groups.

Figure 1: Simplified Framework of Narrative Inquiry Approach used in the Study

Study Sample: Purposive sampling was utilised to identify participants who met specific criteria. Ten deans were recruited who had recently (within the past year) been appointed to lead the establishment of a BS Nursing program at a private college or university in the Philippines as to the date of the study's inception. This ensured that participants had firsthand experience with the current challenges and complexities of the process.

Study Tool: Each dean was interviewed semi-structured. An interview guide was developed beforehand, outlining key topics related to the challenges faced during program establishment (How do newly appointed deans in Philippine colleges of nursing navigate the challenges and opportunities of establishing new BSN programs, as reflected in their narratives?). All interviews were audio-recorded with the participants' informed consent.

Data Collection: A multifaceted approach to data collection was employed to capture the diverse narratives and experiences of newly appointed deans. Initially, the research team identified a purposive sample of deans who had recently assumed their roles in establishing baccalaureate nursing programs within selected Philippine colleges of nursing. Following ethical approval and informed consent procedures, in-depth, semi-structured interviews were conducted with each participant. These interviews, lasting approximately 60-90 minutes each, were guided by a flexible interview guide that explored the deans' experiences in program development, challenges encountered, strategies employed, and personal reflections. Interviews were audio-recorded and transcribed verbatim to preserve the richness of the data. Relevant documents such as program proposals, curriculum outlines, and accreditation reports were collected and analysed to complement and triangulate the interview data. This multi- pronged approach facilitated a comprehensive understanding of the multifaceted process of establishing baccalaureate nursing programs from the perspectives of those directly involved in its implementation.

Data Analysis: Semi-structured interviews were conducted with each dean. An interview guide outlining key topics related to program establishment challenges was developed beforehand to ensure consistency. All interviews were audio-recorded with informed consent. Content analysis was employed to analyse the data (inductive coding, data immersion, initial coding, code refinement, code development, and code creation) (Serafini & Reid, 2023).

Ethical Consideration

The researchers obtained ethical clearance from St. Dominic College of Asia, Philippines with reference number 2024-REC-FR-00028-DEL-REC on 31st January, 2024.

RESULTS

This qualitative study explored the experiences of newly positioned Deans of Philippine Colleges of Nursing as they navigated the intricate process of establishing BS Nursing programs. Their narratives unveiled a complex interplay of challenges and opportunities, highlighting the multifaceted nature of this endeavour. This discussion delves into the major themes that emerged, providing insights into the complexities of establishing a successful nursing program in the Philippine context.

Securing Qualified Faculty. The demand for experienced nurses often outpaces the supply, particularly for specialised areas like neonatal and geriatric nursing. One participant narrated:

The biggest challenge was securing qualified faculty. The demand for experienced nurses often outpaces the supply, particularly for various niche specialisations. The network had to be leveraged to identify nurses with postgraduate qualifications who were passionate about education. Competitive packages and opportunities for ongoing professional development were also offered to attract and retain top talent. Participant No. 8

Obtaining Accreditation: A major hurdle was meeting all the Philippine Commission on Higher Education's (CHED) infrastructure, curriculum, and faculty qualifications requirements. One participant mentioned:

Obtaining accreditation was a long and arduous process. Meeting all the Philippine Commission on Higher Education's (CHED) requirements for infrastructure, curriculum, and faculty expertise was a major hurdle. The facilities were meticulously evaluated to ensure they met the space and equipment standards. Participant No. 10

Securing Clinical Placements: Hospitals often have limited capacity for student nurses, and competition from other institutions can be fierce. Securing adequate clinical placements for students was a constant struggle, as narrated:

Securing adequate clinical placements for our students was a constant struggle. Hospitals often have limited capacity for student nurses, and competition from other institutions can be fierce. Strong relationships with healthcare facilities had to be developed, emphasising the benefits of partnering with the program. Flexible scheduling arrangements were negotiated to accommodate both the hospital's and the students' needs. Participant No. 5

Financial Investment: The initial financial investment was significant. Crucial expenses included acquiring state-of-the-art simulation equipment, renovating labs to meet CHED standards, and investing in technology infrastructure. One participant surmised:

The initial financial investment was significant. Acquiring state-of-the-art simulation equipment to create realistic learning environments for students to practice essential skills before encountering real patients was considered a crucial expense. Participant No. 10

Attracting Students: The nursing profession remains highly competitive, with numerous institutions offering BS Nursing programs. Attracting a strong initial cohort of students proved more challenging than expected.

Attracting a strong initial cohort of students proved more challenging than expected. The nursing profession remains highly competitive, with numerous institutions offering BS Nursing programs. A comprehensive marketing campaign had to be implemented to raise awareness about the program and its unique offerings. Participant No. 7

Balancing Theory and Practice: A strong foundation in nursing theory is essential, but students also need ample opportunities to develop essential hands-on skills. Maintaining a balance between theory and practical training was crucial. One participant described her experience:

Maintaining a balance between theory and practical training was crucial. A strong foundation in nursing theory is essential, but students also need ample opportunities to develop essential hands-on skills. A well-structured curriculum was implemented with close collaboration between classroom instructors and clinical preceptors to ensure a seamless transition for students as they applied their theoretical knowledge in real-world settings. Participant No. 4

Keeping Curriculum Current. The nursing field is constantly advancing, with new technologies emerging, best practices being refined, and areas of specialisation gaining prominence. Staying current with the evolving healthcare landscape was a constant challenge.

Staying current with the evolving healthcare landscape was a constant challenge. An advisory board was formed with experts from various healthcare fields to provide ongoing guidance on curriculum development and ensure the program remained relevant to the profession's ever-changing needs. Participant No. 9

Managing Student Expectations. A BS Nursing program is academically rigorous, demanding high commitment and dedication from students. Managing student expectations was crucial.

Managing student expectations was crucial. A BS Nursing program is academically rigorous, demanding high commitment and dedication from students. A robust student support network was implemented with academic advisors, mental health counsellors, and peer mentoring programs to provide guidance and emotional support for students throughout their academic journey. Participant No. 8

Balancing faculty and student needs. Finding the right balance between faculty needs and student needs was essential. Attracting and retaining qualified faculty members with strong expertise and a passion for teaching while creating a program that fostered faculty development and provided opportunities for ongoing learning and professional growth proved challenging.

Finding the right balance between faculty needs and student needs was essential. Attracting and retaining qualified faculty members with strong expertise and a passion for teaching was essential. Additionally, a program had to be created that fostered faculty development and provided ongoing learning and professional growth opportunities. Participant No. 3

Figure 2: Summary of Dean's Narratives on the Challenges and Opportunities in Establishing Baccalaureate Nursing Program

Figure 2 presents a summary of the challenges and opportunities experienced by newly appointed deans in establishing BSN programs. A primary challenge identified by the deans was securing qualified faculty, with a shortage of experienced educators in specialised nursing fields. Obtaining accreditation was another significant hurdle, requiring adherence to strict standards for infrastructure, curriculum, and faculty qualifications. Clinical placements also posed difficulties, as hospitals had limited capacity for student placements, increasing competition among nursing schools.

Financial investment was a crucial concern, as substantial resources were needed to acquire simulation equipment, renovate labs, and develop technology infrastructure. Attracting students to new programs was challenging due to fierce competition from established institutions, requiring deans to implement effective marketing strategies to highlight the unique features of their programs. Balancing theoretical instruction with hands-on practical experience was another obstacle, ensuring students received the necessary clinical exposure while maintaining academic rigor.

Deans also faced the challenge of keeping the curriculum current, ensuring it aligned with evolving healthcare standards and practices. Managing student expectations was essential, as the demanding nature of the program required clear communication about the academic and professional challenges ahead. Finally, balancing faculty and student needs was crucial in maintaining a supportive and effective learning environment.

DISCUSSION

This narrative inquiry delved into the experiences of newly appointed Philippine Colleges of Nursing deans as they navigated the complexities of establishing Bachelor of Science in Nursing (BSN) programs. Their narratives revealed a multifaceted interplay of challenges, including securing qualified faculty, obtaining accreditation, securing clinical placements, managing financial investment, attracting students, balancing theory and practice, keeping the curriculum current, managing student expectations, and achieving a balance between faculty and student needs.

Securing Qualified Faculty: A recurring theme throughout the Deans' narratives was the struggle to recruit and retain qualified faculty. Such shortage compels Deans to make difficult choices, often compromising on faculty experience or qualifications, potentially impacting the quality of education delivered. Confronting nursing and faculty shortages is a significant challenge, as nurse educators must possess the requisite knowledge, skills, and experience to provide high-quality instruction (Clochesy et al., 2019; Derby-Davis, 2014). Programs must address the shortage of qualified instructors, which can affect the clinical teaching and learning environment, to maintain the quality of nursing education, which can lead to long-term detrimental effects on practicing nurses (Calaguas, 2023).

Obtaining Accreditation: Deans described the accreditation process as time-consuming and resource-intensive, diverting valuable time and energy from other crucial aspects of program development. Accreditation is a vital process that ensures nursing programs meet established standards and maintain the integrity of the nursing profession. Tereso, Tullao and Tullao Jr (2000) described the Philippine BSN program within the limitations of international standards, but economic factors have hindered entire investment in the curriculum.

Securing Clinical Placements: Securing adequate and high-quality clinical placements for students emerged as a critical challenge. According to Fathi and Ibrahim (2023), adequate clinical training is essential for nursing students to develop the necessary skills and competencies to provide safe and effective patient care. However, the availability of high-quality clinical sites and preceptors can be a significant challenge, as programs must compete for limited resources and placements. The education issues include a lack of qualified faculty and clinical sites to allow for more students to be accepted into the programs (Rich & Nugent, 2010; Rodriguez, 2013).

Financial Investment: Establishing and maintaining a BS Nursing program requires significant financial investment, a challenge exacerbated by the often-limited resources available to newly established programs (Merkley et al., 2023). The Deans described the constant struggle to balance competing financial priorities, including faculty salaries, infrastructure development, equipment procurement, and student support services (Salmond & Macdonald, 2021). The education issues include a lack of qualified faculty and clinical sites to allow more students to be accepted into the programs (Nardi & Gyurko, 2013). These issues can be addressed, but changes must be implemented.

Attracting Students: Newly established programs often face an uphill battle in attracting students, competing with established institutions with long-standing reputations. The Deans emphasised the importance of developing a strong brand identity, showcasing the program's unique strengths and offerings. This includes highlighting the quality of faculty, innovative curriculum, state-of-the-art facilities, and strong clinical partnerships (McCracken et al., 2016).

Balancing Theory and Practice: A prominent theme woven throughout the Deans' narratives was the constant struggle to harmonise theoretical knowledge and practical application. Nursing demands a unique blend of critical thinking, clinical judgment, and hands-on skills. Deans expressed concerns about the potential disconnect between classroom learning and real-world clinical experiences. This underscores the need for innovative pedagogical approaches that bridge the theory-practice gap. Oh and Yang (2019) claimed that integrating the latest evidence- based practices, health education, and research into the curriculum is crucial to upholding nursing program quality and remaining compliant with global standards.

Keeping Curriculum Current: Deans emphasised the constant need to adapt and update the curriculum to reflect the latest advancements in medical technology, evidence-based practice, and evolving healthcare policies. Establishing a dedicated curriculum review committee comprising faculty, clinical partners, and industry experts can ensure the curriculum remains relevant and responsive to the changing needs of the healthcare system (Bernardino et al., 2023).

Moreover, embracing technology in the curriculum can significantly enhance students' learning experiences and prepare them for the digital transformation of healthcare (Johnson & Carrington, 2023; Penaflor-Espinosa, 2016). Integrating telehealth simulations, electronic health record systems, and data analytics tools can equip graduates with the skills and knowledge to thrive in the increasingly technology-driven healthcare landscape (Penaflor-Espinosa, 2016). By maintaining a current and relevant curriculum, nursing programs ensure that their graduates are well-prepared to navigate the ever-evolving healthcare environment. Chan (2013) argued that nurse educators must be willing to step out of their comfort zones and design imaginative and innovative ways to educate nurses in the future.

Managing Student Expectations: The deans also grappled with managing student expectations, particularly in a new program still establishing its reputation and identity. Students often enter nursing programs with preconceived notions about the profession, influenced by media portrayals, personal experiences, and societal expectations. Deans emphasised the importance of clear and transparent communication with students from the outset, providing realistic previews of the program's demands, challenges, and rewards (Crombie et al., 2013).

Balancing Faculty and Student Needs: Deans expressed the inherent tension of their roles: fostering a supportive learning environment for students while cultivating a fulfilling and sustainable work environment for faculty (MacPhee et al., 2009). On the one hand, faculty members require adequate support, resources, and professional development opportunities to maintain their expertise and deliver high-quality instruction. On the other hand, while faculty needs are paramount, deans remain acutely aware that student success is the program's core objective. Students need access to experienced, dedicated faculty who can provide personalised guidance, mentorship, and a supportive learning experience. Nurse educators must find innovative ways to address these competing needs by promoting faculty retention, investing in professional development, and fostering a collaborative culture between faculty and students.

Students, especially those transitioning from different academic backgrounds or facing challenges, require robust support. Also, clinical placements are essential for developing practical skills and clinical judgment (Høegh-Larsen et al., 2023). For instance, Smith (2022), Smith et al. (2019), and Kalb et al. (2012) examined the experiences of nursing faculty in leadership roles, highlighting the importance of mentorship and collaboration. The present study echoes these findings, emphasising the crucial role of collaborative efforts among stakeholders in establishing nursing programs. However, this research diverges from previous work by specifically focusing on the unique perspectives of newly appointed deans in the Philippine context.

Limitation

While this study provides valuable insights, it has some limitations. As the study focuses on Philippines, it may make it less applicable to other settings. Future research with a larger, more diverse sample and longitudinal data could offer a more complete understanding of the experiences of new nursing deans.

CONCLUSION

This study examined the experiences of newly appointed Deans of Philippine Colleges of Nursing as they led the establishment of BSN programs. Their stories revealed both challenges and opportunities in this complex process. Thematic analysis identified key factors influencing program success. Further research can provide deeper insights by applying leadership, organisational change, and curriculum development theories. Using mixed methods and triangulation can strengthen findings. The results can guide the development of support programs for new deans and help policymakers refine nursing education policies better to meet the needs of the profession and healthcare system. The future scope of this research includes exploring the long-term impacts of leadership challenges on the success of BSN programs, faculty retention, and student outcomes. Expanding the study to include deans from various regions or countries could provide comparative insights. A longitudinal approach could track program development over time, and incorporating mixed methods could offer a more comprehensive understanding of the factors influencing the establishment and sustainability of BSN programs.

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The authors are deeply grateful for the key informants’ willingness to participate in this study and share their narratives on establishing baccalaureate nursing programs.

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