PhD programs in nursing are similar in purpose in that their primary aim is to prepare nurses as researchers and scholars, and to make significant contributions to the theory, research, and practice bases of nursing. The research and scholarship foci are appropriate and indisputable, and are congruent with the historical development and underlying philosophy of the PhD tradition. However, the need for PhD-prepared nurses to fill administrative positions in nursing schools and complex health service settings has been strongly advocated for the past several decades. Responding to this identified need for role preparation in addition to preparation in research, several PhD programs in nursing throughout the nation have developed tracks (also referred to as research or inquiry areas, or pathways) specific to nursing education and service administration.
A current trend is to offer PhD programs with tracks in executive nursing administration, which prepare both nursing education and service administrators within the same course of studies, in keeping with the belief that administrative theories obtain regardless of the practice site. During seminars, students study research, and discuss and debate administrative issues and topics from both educational and service perspectives, depending upon the students' anticipated employment settings. The discussions thereby enable students to learn about and gain insights into nursing administration in both settings; it is anticipated that eventually collaborative relationships between administrators in educational and service sites should be strengthened.
In addition to course work that prepares them for research roles, PhD students who study executive nursing administration enroll in a variety of relevant and broadly based course work offered through the nursing school and other disciplines, such as political science, management, marketing, business, education, and educational administration. The course work is important and necessary, especially for nursing students whose previous education has had a strong clinical emphasis. In addition, the course work provides students with substantive content and current issues in administration, potential areas in which to initiate a research program, and a knowledge base for their future administrative role. Students, in collaboration with faculty advisors, mutually identify and agree upon the courses in which to enroll based on the students' diverse learning needs. Other factors also influencing the courses that students select include the requirements for course work established by the nursing school; individual research interests; professional goals; employment and educational histories; socialization as PhD students; and other professional and personal considerations, such as work schedules and family demands. All of these factors interplay when students explore and select administration course work in PhD programs. Similarly, faculty who advise students about course work are likewise influenced by their educational preparation and experiences in administration.
Thus, decisions are made about administrative role preparation course work for students based on the interplay of numerous programmatic, student, and faculty considerations. Subsequently, graduates from PhD programs have, by and large, quite consistent preparation in research; but can such a statement be made about the role preparation for executive nursing administration? Hoy and Miskel (1982) raised a similar question in relation to educational administration as they reflected on the "state of the science" in that discipline. They believed ". . . that a substantive body of knowledge . . . was available but neglected by both professors and practitioners, and . . . administrative practices could become less of an art and more of a science" if the knowledge base was applied to practice (p. vii). It is timely to address these questions for the discipline of nursing.
Summary of the Earlier Study
The author and a colleague conducted an exploratory and descriptive study several years ago that examined the educational preparation, role-related competencies and responsibilities, work load, and anticipated career patterns of first-line nurse administrators employed in baccalaureate and higher degree nursing education programs throughout the nation (Princeton & Gaspar, 1991). The following summary of that study, which was approved by the Institutional Review Board at the University of Utah, provides the background for secondary analysis of data reported in this article, and the subsequent recommendations that are proposed.
Methodology and results
Forty-two schools were randomly selected from the then 114 National League for Nursing (NLN)-accredited nursing schools throughout the nation that offered baccalaureate and higher degree programs. The sample was stratified by geographic area and funding source. The deans and directors from 29 (69%) schools in 24 states provided the names and addresses of 90 first-line administrators in their schools, of which 56 (62%) agreed to participate in the study. Prior to telephone interviews, the participants completed an administrative competencies questionnaire (adapted from Jennerich, 1981) and a demographic data collection instrument, and reviewed the list of questions they would be asked during the interview pertinent to their role as academic administrators. A guide was developed based on the research questions, and was used to conduct the telephone interviews. Data were collected on participants' past and current administrative positions in academe and service; administrative education, role preparation, and orientation; perceived strains, conflicts, work overload, and coping strategies; anticipated career in administration; and research and scholarship, teaching, and service responsibilities.
The interview data were computerized to assist the researchers in managing and analyzing the large amount of qualitative data. A content analysis protocol was used (Patton, 1990) to enable the systematic transformation and aggregation of data from the interviews into units that allowed precise identification and description. The data were examined initially; a systematic, comprehensive classification/coding scheme was developed comprised of categories of data; the data were combined into themes and patterns; and recurring regularities in the data were identified. Due to the fact that two researchers coded the data, it was necessary to establish intercoder reliability. This was accomplished by the researchers' coding a sample of the interviews independently using the coding scheme that had been developed, and applying the formula (Miles & Huberman, 1984, p. 63):
intercoder reliability = number of agreements H- total number of agreements + disagreements.
There was 92% intercoder reliability agreement (70% and higher agreement is acceptable).
A composite description of the first-line nurse educational administrator was developed from the data. She was a 49-year-old woman, PhD-educated in a nonnursing discipline, tenured at the associate professor level, and had been employed prior to her current position in an administrative role in an academic or service setting. She had worked an average of three years in her current position in a school that emphasized research over teaching and certainly over service; there were 16 faculty in her unit. In addition to her administrative responsibilities, she also was accountable for meeting the triad of responsibilities traditionally associated with a faculty role. She believed the most important competency that executive nurse administrators must develop is trust - by faculty, by other administrators, and by students; and furthermore, she believed that administrators develop trust by consistently demonstrating fair decision-making behaviors. She spent the majority of time in her administrative role with faculty-related matters, such as recruiting, hiring, negotiating teaching responsibilities, and evaluating; and secondly, with developing and managing the departmental or division's budget.
Although the participants offered numerous comments about administrative know-how that they learned while working on the job, they were clear that in order to optimize PhD programs for nurses who anticipate practicing in executive administrative positions, role preparation courses must be planned into their programs. They justified role preparation in addition to research preparation based on the complexity and demands associated with administrative positions, regardless of the administrative level or employment site.
The participants cited a wide variety of strains, conflicts, and overload that confronted them in their administrator role, which intensified as they also attempted to meet the research and scholarship, teaching, and service requirements inherent in their faculty role. Consequently, 31 of the 56 (55%) participants anticipated that they would not continue or were unsure if they would continue as academic administrators.
Secondary Analysis of Data
In reviewing the interview data collected during the earlier study, two important yet different research questions related to role preparation became apparent that had not been posed by the researchers, but which the participants addressed voluntarily during telephone interviews: (1) Are there knowledge domains specific to the executive nurse administrator role of which practicing administrators must have knowledge, and for which they are held accountable? And if so, (2) What are the curricular implications for PhD programs in nursing that offer an administrative track?
The literature validated that domain and curricular questions have been asked, researched, and reported repeatedly in nursing service administration, but primarily regarding role preparation of nurses at the master's level, with much less attention given to PhD level (e.g., American Association of Colleges of Nursing, American Organization of Nurse Executives, 1986; Barnum, 1990; Boerstler, Krugman, & Blair, 1988; Christensen, 1988; Henry, 1989; Kirk, 1987; McCloskey, Gardner, Johnson, & Maas, 1988; Wagner, Henry, Giovinco, & Blanks, 1988). Much of the literature in nursing educational administration focuses on research-related issues from which knowledge domains and curricular implications specific to role preparation must be inferred (e.g., Conway & Andruskiw, 1983; George & Deets, 1983; Hall, Mitsunaga, & de Tornyay, 1981; Henry, 1989; Henry et al., 1987; Henry, O'Donnell, Pendergast, Moody, & Hutchinson, 1988; Miller, Heller, Moore, & Sylvia, 1987; Tanner, 1986). Several studies, however, have addressed the importance of role preparation at the PhD level for executive nurse administrators. For example, Brimmer et al. (1983) conducted a nationwide survey between 1973 and 1980 on 1,964 licensed professional nurses with earned doctorates. Over one half of the participants (54%) held a PhD degree, about one third (34%) held the EdD degree, and the remaining 12% held professional doctoral degrees from nursing and other disciplines. The participants indicated that they were hired into their first academic positions primarily to teach; but when hired into positions later in their academic careers, there was a sizable shift from teaching to administrative roles. These data beg the question about how these nurses were prepared for the administrative roles they assumed.
Holzerner (1987) conducted a study between 1979 and 1984 on doctoral education in nursing; the majority of programs at that time were PhD programs. He reported data on graduates' "primary activity in present job," "primary purpose in pursuing the doctoral degree," and "preferred future primary job activity." Although 33% of 294 doctorally prepared nurses surveyed indicated that their primary purpose in pursuing a doctoral degree was preparation for scholarly research, and another 40% as preparation for research and teaching, only 9% listed research as their primary duty in their present position, and 27% cited teaching-research. At the same time, there were no data reported from this group that indicated that the primary purpose for doctoral studies was preparation for administration or management; yet 20% indicated that administration-management was their primary activity in their present job. Ketefian (1991) referred to Holzemer's research (1987) as she addressed questions and concerns about the need for doctoral programs in nursing to prepare graduates not only for researcher roles, but for the full faculty role - including administration - which many assume after graduation.
Zebelman and Olswang (1989) reported data collected from 373 PhD students who had begun their studies in 1986 or earlier. Of these students, 34 (9.1%) initially indicated administration in a practice setting as their career goal, while another 24 students (6.4%) indicated educational administration, for a total of 58 (15.5%) who had executive nursing administration as their initial career goal. When these students were surveyed later in their doctoral programs after having been socialized about the research emphasis of PhD programs, 25 students (6.7%) anticipated administration in a practice setting, while 19 students (5.1%) anticipated educational administration, for a total of 44 students (11.8%) who continued to set administrative career goals. These data support the need for role preparation course work in PhD programs that offer administrative tracks.
Methodology and resulte
The secondary analysis (Woods & Cantanzaro, 1988) consisted of reexamining data from the 56 telephone interviews collected during the earlier study, using the content analysis protocol (Patton, 1990) described in this article. The two newly formulated research questions directed the content analysis.
The data indicated that the primary function of administrators in nursing education and service institutions is ethical and accountable decision-making. Three knowledge domains specific to the administrative role were identified, and it is within these domains that decisions are made: organizational structure and governance; resources; and information management. Six categories of courses were identified that emanate from the domains, and these courses prepare executive nurse administrators for decision-making:
* missions and goals
* policies and politics
* human resources
Summary of Findings: Decision-Making
* financial and material resources
* communication management.
There are numerous content areas within the categories of courses aimed at role preparation. The Figure summarizes these findings.
To elaborate on the findings, ethics theories - relational ethics as well as biomédical ethics - and decision-making theories are integrated throughout the course work, although separate courses on ethics and decision-making may be offered. Courses on missions and goals emphasize the nursing unit's philosophy, purpose, and objectives, and are congruent with the historical development and mission of the larger organization. Systems analysis aids in understanding how the broader institution and the nursing unit therein articulate and function interdependently, while the future of nursing education and service units relies heavily on the nurse administrator's forecasting, strategic planning, and change agentry skills.
Courses on policies and politics focus on the use of the administrative process to operationalize the nursing unit's mission and goals, and to structure and administer a nursing unit in terms of procedures, legalities, and regulations within the context of the broader environment. Institutions are guided by particular policies; however, the establishment and implementation of these policies undergo group consultation, collaboration, and acceptance, all entailing review, revision, negotiation, and compromise; that is, politics. In addition, executive nursing administration involves confronting and problem-solving numerous obstacles, a major one of which is the conflict that occurs when educated and experienced professionals are employed in bureaucratically structured institutions. Thus, the dynamic procedures through which policies are implemented are organizationally described as politics.
Human resources course work focuses on the executive nurse administrator's leadership role in the recruitment, development, and evaluation of personnel, and with employment practices. Courses in financial and material resources emphasize the role of the executive nurse administrator in acquiring and allocating resources; in preparing, monitoring, and managing the budget; and in analyzing costs. Course content on the management of databases addresses the various nursing records in educational and service units that must be identified, set up, used, maintained, evaluated, and revised as necessary.
Communication management highlights the importance of the timely transmission of data and knowledge to members in an organization; the flow of facts and figures through inter- and intraorganizational networking with nursing and interdisciplinary colleagues; an understanding of the most effective and efficient problem-solving and conflict-resolution strategies; and the exercise of interpersonal communication skills expected of executive nurse administrators. The ability to write is also of utmost importance, whether these skills are used to prepare formal grant proposals and papers or less formal memos for staff and other personnel. The Figure displays a summary of data that may be useful in developing PhD-level curricula to prepare nurses for executive nursing administration roles in education and service institutions. The examples of content and topics cited under the six categories of courses are not presented in order of priority and should not be considered all-inclusive. To the contrary: as with the domains and categories of courses, the listings of content are fertile areas for discussion and debate, delineation, refinement, and organization.
A secondary analysis of interview data collected from nurse administrators during an earlier study was conducted to answer two newly formulated research questions regarding role preparation for executive nurse administrators. Results supported that, in addition to research preparation, role preparation at the PhD level was important for nurses who intend to pursue careers in executive nursing administration. Ethical and accountable decision-making was identified as the primary function of executive nurse administrators, regardless of whether they are employed in educational or service institutions. Three domains were identified in which administrators make decisions from which six categories of role preparation courses and potential course content were identified. The intent of this paper is not to suggest a rigid curricular model; rather, it is to stimulate further research and dialogue among colleagues regarding the preparation of nurses at the PhD level for roles as executive nurse administrators.
- American Association of Colleges of Nursing and the American Organization of Nurse Executives. ( 1986). Position statement on graduate education in nursing administration. Journal of Professional Nursing, 2, 263.
- Barnum, B.J. (1990). Doctoral education for nurse executives. In C. Little (Ed-), Nursing and health care: The supplement (NLN Publication No. 41-2365, pp. 57-61). New York: NLN.
- Boerstler, H., Krugman, M., & Blair, E. (1988). Preparing nurse executives for tomorrow's health management challenges. Journal of Nursing Administration, 1S(4), 6, 29.
- Brimmer, PE, Skoner, M.M., Pender, N.J., Williams, C.A., Fleming, J.W., & Werley, H.H. (1983). Nurses with doctoral degrees: Education and employment characteristics. Research in Nursing and Health, 6, 157-165.
- Christensen, PJ. (1988). An ethical framework for nursing service administration. Advances in Nursing Science, 10(3), 46-55.
- Conway, M.E., & Andruskiw, O. (1983). Administrative theory and practice. Norwalk, CT: Appleton-Century-Crofts.
- George, S., & Deets, C. (1983). Top academic nurse administrators' perceptions of essential behaviors for their positions. Nursing Leadership, 6, 44-55.
- Hall, B., Mitsunaga, B., & de Tornyay, R. (1981). Deans of nursing: Changing socialization patterns. Nursing Outlook, 29, 92-95.
- Henry, B. (1989). The crisis in nursing administration education. Journal of Nursing Administration, 19(3), 6-28.
- Henry, B., Moody, L.E., Pendergast, J.F., O'Donnell, J.F., Hutchinson, S.A., & Scully, G. (1987). Delineation of nursing administration research priorities. Nursing Research, 36, 309-314.
- Henry, B., O'Donnell, J.F., Pendergast, J.F., Moody, L.E., & Hutchinson, S.A (1988). Nursing administration research in hospitals and schools of nursing. Journal of Nursing Administration, 18(2), 28-31.
- Holzerner, W.L. (1987). Doctoral education in nursing: An assessment of quality, 1979-1984. Nursing Research, 36, 111-116.
- Hoy, W.K, & Miskel, G.G. (1982). Educational administration: Theory, research, and practice. New York: Random House.
- Jennerich, E.J. (1981). Competencies for department chairpersons: Myths and realities. Liberal Education, 67, 40-70.
- Ketefian, S. (1991). Doctoral preparation for faculty roles: Expectations and realities. Journal of Professional Nur sing, 7, 105-111.
- Kirk, R. (1987). Management development: A needs analysis for nurse executives and managers. Journal of Nursing Administration, 17(4), 7-8.
- McCloskey, J.C., Gardner, D., Johnson, M., & Maas, M. (1988). What is the study of nursing service administration? Journal of Professional Nur sing, 4, 92-98.
- Miles, M.B., & Huberman, A.M. (1984). Qualitative data analysis: A sourcebook of new methods. Beverly Hills: Sage.
- Miller, P.G., Heller, B.R., Moore, H.W., & Sylvia, B.A. (1987). Research in nursing education administration: State of the art. Journal of Professional Nursing, 3, 143-147.
- Patton, M.Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.
- Princeton, J.C., & Gaspar, T.M. (1991). First-line administrators in academe: How are they prepared, what do they do, and will they stay in their jobs? Journal of Professional Nursing, 7, 79-87.
- Tanner, C.A. (1986). Research in nursing education: Renaissance or regression? Nursing and Health Care, 7, 343.
- Wagner, L., Henry, B., Giovinco, G., & Blanks, C. (1988). Suggestions for graduate education in nursing service administration. Journal of Nursing Education, 27, 210-218.
- Woods, N.F., & Cantanzaro, M. (1988). Nursing research: Theory and practice. St. Louis: C.V. Mosby.
- Zebelman, E.S., & Olswang, S-G. (1989). Student career goal changes during doctoral education in nursing. Journal of Nursing Education, 28, 53-60.
Summary of Findings: Decision-Making