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AACN Issue Bulletin
July 1996

Nursing Schools Seek Balance of Teaching
and Research Skills in Effort
to Boost the PhD Supply

As employers of doctoral-degree graduates, colleges and universities are losing market share. By a slim margin, the nation's campuses continue to be the major employer of doctorate recipients, granting jobs to 52 percent of all new PhDs who accepted employment in 1993, according to the U.S. Department of Education. But that figure is down markedly from 68 percent in 1970. Moreover, a significant proportion -- 17 percent of all doctoral-degree recipients with employment commitments in 1993 -- opted to begin their careers in business and industry.

Overall, institutions awarded 27,105 doctorates to U.S. citizens in 1994, three percent more than a decade earlier, according to a study by the National Research Council. Still, the Education Department projects the number of doctoral degrees granted in the year 2005 will fall 11 percent below 1993 levels.

The Situation in Nursing

Currently at 62, the number of doctoral programs in nursing at U.S. universities has grown from 38 just ten years ago, and up from 14 in 1976. Moreover, nursing schools report plans to develop an additional 17 doctoral programs, according to a survey by the American Association of Colleges of Nursing (AACN).

But while awards of new nursing PhDs grew to 401 in 1995, the increase occurred at an average of nine additional graduates in each of the previous five years, a snail's pace educators say is far below the rate needed to expand nursing's research base to address a growing list of contemporary health problems. "If you're master's-prepared, you're an expert clinician but you don't have sufficient research skills to produce new knowledge independently," says Joan Magilvy, director of the doctoral program at the School of Nursing at the University of Colorado Health Science Center.

Nursing is a clinical profession, educators say, and both research expertise and clinical knowledge are required to generate nursing and other health care advances. Taken largely for granted by the public as medical innovations, breakthroughs including patient education and many intensive care techniques in fact grew out of nursing science, and are part of a fast-expanding field that not only includes research on nursing care, but studies by nurses on an array of critical health disorders. Researchers point to recent investigations by nurse scientists that have led to cost savings and better outcomes in care for low birthweight infants, better care for Alzheimer's patients and their caregivers, and improved treatment of patients with chronic conditions. It is in doctoral programs, educators explain, where nurses are guided on how to collect data, how to publish, how to secure research funding, and how to maintain the integrity of a research project.

Indeed, in states where nursing schools are working to get new doctoral programs approved, some of the support is from physicians. "Vice presidents of health science and deans of medicine at academic health centers are saying they want doctorally prepared nurses working on their collaborative teams," notes Rita Carty, dean of the College of Nursing and Health Science at George Mason University in Fairfax, Virginia. "As nurses have moved into the community, there's been this awakening [by physicians] that nurses bring skills in health promotion and disease prevention that physicians traditionally haven't had, and that they're more expert and comfortable than physicians at working in community sites. There's a recognition and acceptance that researchers in hospitals should be doctorally prepared, and that doctoral education in nursing is essential to move the discipline forward."

Of the nation's 2.2 million registered nurses in 1992, about 8 percent had graduated from master's-degree programs that are the chief supplier of candidates for doctoral education, according to the Division of Nursing of the U.S. Department of Health and Human Services. But while doctoral enrollment at nursing schools nationwide rose an average of 41 students annually since 1991, to 2,890 in fall 1995, enrollments in 1995 dipped slightly for the second consecutive year, down barely more than 1 percent below the level 12 months earlier, the latest AACN survey shows.

Educators suggest some of the enrollment slide may be due to uncertainty and volatility in the health system, making some master's-prepared nurses reluctant to leave their current positions for the expense and lost income that doctoral education incurs. At several schools, however, the reduction is by design and due to a shortage of resources, not applicants.

"We've just admitted 12 new students. But we couldn't admit more because of lack of faculty," says George Mason's Rita Carty. "You can't have doctoral students without the people to mentor them."

Likewise, at the University of Colorado, "we're downsizing our program a bit," says Joan Magilvy. Over the next several years, the school will admit fewer students to each year's class in an attempt to phase down its current doctoral enrollment of 75 to about 55. "We want to ensure that we maintain a balance of enough senior and research faculty who can mentor." Plans include ending the program's summer-only option, one of the few in the U.S. to offer students -- many of whom could not attend at other times of the year due to job commitments -- the flexibility of intensive doctoral study over summer months. The session will close after admitting its last class in 1997.

Concerns for mentor-to-student ratios also have kept growth of doctoral enrollments to a minimum at other schools such as the University of Washington and the University of Michigan. However, to boost enrollments that have declined slightly over the last few years, the University of Virginia has engaged in "aggressive" recruitment of doctoral students using brochures and World Wide Web announcements describing faculty members' research, as well as personal follow-up to applicants by faculty researchers, says nursing dean Jeanette Lancaster.

Other schools fear that their lack of a doctoral program may hurt their ability to lure doctorally prepared faculty in the future. "Students have to leave the state and drive three or four hours to the closest doctoral program," says dean Anne Peirce of the School of Nursing at the University of Mississippi Medical Center. "Once they make the time commitment and get involved in the culture of the other school, the risk that they'll stay [as faculty] becomes greater."

The Need for PhD Faculty

At AACN-member schools, the proportion of doctorally prepared faculty has climbed sharply in the last two decades, from 15 percent in 1978 to 50 percent in 1995. Still, educators say, higher numbers are needed to prepare teaching staff with the skills to generate new science and to pass on research know-how to future nurse scientists. The task faces several challenges. "Half the people with doctorates who apply for faculty positions here have their PhDs in other fields," explains Joyce Fitzpatrick, dean of the Frances P. Bolton School of Nursing at Case Western Reserve University. Moreover, of the nation's 54 nursing doctoral programs in 1992, only 23 -- including Case Western Reserve -- had been designated by the National Institute of Nursing Research as having "research-intensive" environments. "Bottom line, it does make a difference where you go to school," Fitzpatrick adds. "We don't want someone coming out of a PhD program without publishing experience. We not only look for our doctoral students to publish with their faculty mentors but to know how to access small grant funding for their dissertations," Fitzpatrick adds.

Educators concede that the best combination of faculty should be used by each institution, and that -- for example -- a college with only a baccalaureate-degree program in nursing may not need most faculty to be PhD-prepared. But for doctoral programs, deans indicate their need for faculty who not only hold nursing doctorates but also have track records in scholarship, research programs in place, and can provide seasoned guidance and mentorship.

Wanted: Teaching Experience

As the breadth of fields within nursing grows, so has the possibility that graduates will not teach in a university once they earn the doctorate. Indeed, educators say, teaching can no longer be assumed to be the first career choice for nursing's new PhDs. "A lot of our PhD graduates are going into research and clinical jobs in health care companies," says Sue Hegyvary, dean of the School of Nursing at the University of Washington.

Indeed, those who opt for teaching still pose a dilemma for the profession, says the University of Colorado's Joan Magilvy. "We want the best qualified teachers, but teaching how to teach is not the primary purpose of doctoral education." Educators acknowledge the central need for faculty to be skilled teachers who understand educational psychology, curriculum design, and the evolution of nursing curricula. They recognize, too, the role of doctoral programs in preparing registered nurses for careers in such other areas as health policy. But many educators are just as quick to assert their view that the major goal of doctoral education is to develop new knowledge and a future cadre of nurse scientists. "Right now, if I have a whole group of applicants for a teaching post, I'd hire the stronger researcher, since research is the most difficult skill to learn," says dean Ada Lindsey of the College of Nursing at the University of Nebraska Medical Center.

Most doctoral students enter their programs after master's instruction, which focuses on clinical, rather than teaching, skills. As a result, after receiving their doctorates, many new faculty overwhelm students with information overload by "trying to put their whole programs into one course. They don't know how to construct tests, counsel students, or use teaching strategies effectively," explains George Mason University's Rita Carty. To help reverse the situation, recruitment ads placed by the school seek faculty who have teaching experience as well as preparation in curriculum theory.

"We know that one-on-one mentoring with an expert helps someone to learn," says the University of Mississippi's Anne Peirce. Most recently, during her four years directing the doctoral program at the School of Nursing at Columbia University, the program established a requirement for students interested in teaching careers to work in mentored teaching experiences. Although many doctoral programs in nursing give students the option to also work as research or teaching assistants, few require it. In Columbia's case, students take a required teaching practicum and work four to six hours a week for a semester being mentored by a seasoned faculty member. At the University of Virginia, a one-year mentorship for doctoral teaching assistants is in the planning stage. At other schools, such as the University of Illinois at Chicago, nursing students gain teaching experience in certificate programs at the master's, doctoral, and postdoctoral levels.

Even with teaching experience, many doctorally prepared nursing faculty do not continue in direct clinical practice. "We start losing [master's graduates] when they don't become enmeshed in education. We need to encourage students not to look at the master's as the terminal degree for clinical experience," says Kathleen Potempa, interim dean of the College of Nursing at the University of Illinois at Chicago. In October, Potempa will assume the deanship at the School of Nursing at Oregon Health Sciences University.

Although less than half of doctoral faculty at the University of Nebraska School of Nursing are engaged in active clinical practice, faculty are encouraged to continue practicing at area clinical sites and to develop practice agreements with local agencies, says dean Ada Lindsey. More than ten of the school's PhD faculty have completed a two-year program to become certified as nurse practitioners and now include practice at on- and off-campus clinics as part of their faculty role. The effort benefits both the school and community, Lindsey says. In 1995, Nebraska had fewer than 100 nurse practitioners to provide needed primary care for the entire state. Similarly, at the University of Virginia, 11 faculty -- many of them doctorally prepared -- recently completed a one-time program by the school to prepare nurse practitioners to combine teaching with active clinical practice.

Finding a Niche

Though several deans report they have not seen a sizable exodus of PhD faculty due to higher salaries at other schools or practice settings, salary rises in academia may not be as sustainable as in the health care market. As a result, the loss of faculty to more competitively paying schools or practice sites remains a constant threat. To help ward it off, educators not only are urging more vigorous federal support for doctoral nursing education, including for traineeships, but point to the need for nursing scientists to seek grant funding from more nontraditional sources, including agencies of the National Institutes of Health outside the National Institute of Nursing Research.

As supplies of personnel and finances tighten, more schools also are being pushed to make the most creative use of current resources. "We've asked what is our market niche — what is unique about us that would make students want to come here," says the University of Virginia's Jeanette Lancaster. The answer has been to offer preparation different from the state's two other doctoral programs by focusing research and teaching on care for high-risk populations. "We're one of the few major medical centers in a rural area, and almost without exception, our faculty are working with rural populations and other medically underserved, such as rural women with clinical depression," Lancaster says.

Increasing the PhD supply also may require more complete use of candidates already in the pipeline. Even with the steady growth in master's-degree enrollments in recent years, nursing schools still are not producing enough master's graduates to supply the doctoral pool, says Dolores Sands, dean of the School of Nursing at the University of Texas at Austin. "We have to open up the bottleneck of master's students" not only by encouraging more of them to go on to doctoral careers, but by socializing master's students earlier to research roles, Sands adds. "It might not hurt for master's students to get their feet wet by having at least one clinical project published before they graduate. And not for the sake of publishing, but for what it signifies -- that we're producing thinkers to lead us into the next century" with clinical improvements.

In addition, "while we're finally getting postdoctoral programs underway, we need to open more of them for people whose research training has been less intensive," says the University of Michigan's Ada Sue Hinshaw, who most recently was director of the National Institute of Nursing Research. Candidates with postdoctoral experiences not only are equipped with more complete research skills, educators say, but ultimately do better at sustaining a research career.

Still, the biggest obstacle to swelling the ranks of PhD faculty may lie with faculty themselves. In 1994, the average age of a full-time, doctorally prepared nursing professor was 54, AACN figures show. Doctorally prepared associate and assistant professors that year had average ages of 51 and 47, respectively. Indeed, the average retirement age for full-time nursing faculty was 62 in 1991, according to the latest AACN data. "That's a short trajectory in which to develop research," Hinshaw explains.

Not only must students and practicing nurses not assume that RNs can enter research careers only in later life, but additional ways to attract and socialize nursing students to academic roles at a younger age need to be put into place, educators urge. Deans point to a number of solutions, such as identifying and encouraging baccalaureate and master's students who have teaching abilities to pursue doctoral careers and involving students in the practice and research projects of doctorally prepared nurse clinicians. At the other end of the age spectrum, continuing to use the skills of retired faculty could help stabilize the PhD pool further. A campus-wide program at the University of Washington allows faculty who retire to be rehired at 40 percent of their most recent base salary and to continue to teach for up to five years, says nursing dean Sue Hegyvary.

Says Hinshaw, "Think of what could happen if [faculty] had 30 to 40 years of productivity, instead of less than 20 currently. Nursing would produce more science, more leaders in health care, and be more visible and influential on so many more fronts."

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