Dr. Nehls is Associate Dean for Academic Programs and Professor, and Ms. Barber is Assistant Dean for Academic Programs, University of Wisconsin-Madison School of Nursing, Madison, Wisconsin.
Presented in part at the American Association of Colleges of Nursing Doctoral Education Conference, January 2007, Captiva, Florida; American Association of Colleges of Nursing Doctoral Education Conference, January 2011, San Diego, California; and Global Alliance for Leadership in Nursing Education and Science, December 2010, Arlington, Virginia.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Nadine Nehls, PhD, RN, Associate Dean for Academic Programs and Professor, University of Wisconsin-Madison School of Nursing, 600 Highland Avenue, Madison, WI 53792-2455; e-mail: firstname.lastname@example.org.
The need for nurses with research-intensive preparation is a long-standing problem that is now reaching crisis proportions. Recently, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation joined forces to consider the future of nursing in light of health care reform. One recommendation from their recently released report, The Future of Nursing: Leading Change, Advancing Health, concerns increasing the cadre of nurse faculty and researchers by doubling the number of nurses with a doctorate by 2020 (IOM, 2010).
To address the need for nurse researchers, a proportion of new doctoral students must complete research-intensive doctoral nursing programs. Research-focused doctoral programs prepare students to pursue intellectual inquiry, conduct independent research, and develop the science that supports the discipline and practice of nursing. The PhD, or Doctor of Philosophy degree, is the most commonly offered research-focused degree. However, some schools award a Doctor of Nursing Science (DNS or DNSc) as the research doctoral degree. In either case, students who complete research-focused doctoral programs are traditionally prepared to pursue careers in research and teaching (American Association of Colleges of Nursing [AACN], 2001).
The Current State of Research-Intensive Doctoral Programs in Nursing
In the United States, the limited number of nurses with research-intensive earned doctorates is of great concern. It has been estimated that less than 1% of nurses (28,369) have an earned doctoral degree in nursing or a related field (IOM, 2010). During the past decade, the numbers of new graduates of research-intensive programs has remained relatively constant, with the exception of 2009 when enrollments increased by 5.1% (AACN, 2010b). Low enrollment and graduation rates have persisted despite the fact that the number of research-intensive doctoral programs in nursing increased from 103 in 2006 to 124 in 2010 (AACN, 2010a, 2011). The flat graduation rates despite the increased opportunities can be attributed to both the recruitment and matriculation of students.
Recruitment of nurses to doctoral study stands in sharp contrast to that of other disciplines. In general, nurses begin doctoral education at a significantly older age than other doctoral students. It has been estimated that the median age of graduates from nursing doctoral programs was 47 (AACN, 2006), compared with 32.7, the median age of all doctoral awardees (Bell, 2009). The result is that the average age of the assistant professor in nursing is 52, nearly 20 years older than assistant professors in other disciplines (AACN, 2010c). Matriculation and progression of nursing students also differs from students in other disciplines. The mean number of years from completion of a baccalaureate degree to graduation from a research-focused doctoral program in nursing is 21.8 years, compared with 12.7 for all research-focused doctoral programs (AACN, 2006). This longer trajectory is a function of not being continuously enrolled in graduate study and pursuing part-time rather than full-time study (AACN, 2006). The end result of beginning doctoral study later in life and matriculating more slowly is that nursing graduates have a shorter time period during which to make significant contributions to the field.
The problems around research-intensive nursing education have been recognized by nursing thought leaders for some time. Recently, one of the charges to the AACN task force on the preferred future of PhD education in the nursing was the exploration and establishment of programs that more rapidly transition students from the baccalaureate or master’s entry-level degree to research-focused doctoral programs in nursing (AACN, 2010d). Earlier matriculation and full-time study may better enable graduates to develop sustained programs of research and teaching over longer periods of time (AACN, 2006).
One educational pathway to the PhD that brings younger faculty and scientists into nursing is the baccalaureate-to-doctoral option. These programs of study admit students to doctoral education after completion of the baccalaureate degree and are often referred to as accelerated or fast-track PhD programs. AACN’s latest survey shows that 105 baccalaureate-to-doctoral programs are now available, with an additional 54 programs under development (AACN, 2010a). Several descriptive reports provide useful information about the challenges and opportunities of implementing post-Bachelor of Science in Nursing (BS)-to-PhD programs (Bond, 2009; Fontaine & Dracup, 2007; Williams, 2007). However, the effects of post-BS admission to doctoral study have not been systematically studied and substantiated, nor is there documentation of the proportion of baccalaureate-to-doctoral programs that are research versus nonresearch intensive.
The future of PhD education in nursing is at a crossroads. Schools of nursing can continue to enroll primarily postmaster’s degree students and a growing number of postbaccalaureate students into research-intensive doctoral programs. However, these approaches have been tried and, as yet, have had little effect on improving the graduation rates of PhD-prepared nurses. It is time for an additional pathway to the PhD. An option that may prove to offer added advantages is an even earlier entry to PhD study. Recruiting and enrolling students before or while they are baccalaureate students may prove to be the best option for maximizing the number and productivity of future nurse researchers. Thus far, there are only two prebaccalaureate-to-PhD programs in nursing in the United States, to our knowledge.
The Prebaccalaureate Entrance to Research-Intensive Doctoral Programs
A new pathway to research-intensive doctoral study in nursing has been in existence at the University of Wisconsin-Madison for approximately 5 years. The prebaccalaureate entrance to PhD nursing education, or Early Entry Option, is designed for undergraduate students who are interested in pursuing a research career in nursing. Three degrees are awarded to students who complete this option: a BS degree, granted by the University of Wisconsin-Madison, and a Master of Science in Nursing (MS) and PhD, granted by the University of Wisconsin-Madison Graduate School. The minimum credits required for each degree are 124 credits for the BS degree, 36 credits for the MS degree, and 52 credits for the PhD degree. Students are permitted to substitute some graduate-level courses for undergraduate courses or MS courses, where appropriate, thereby reducing the total number of credits required at the graduate level. With the assistance of a faculty advisory committee, early-entry students plan an individualized program of study and research, drawing on existing undergraduate and graduate courses in nursing and related disciplines. The curriculum is composed of research training, clinical practice experience, and coursework.
An integral component of the Early Entry PhD Option is research training. The University of Wisconsin-Madison School of Nursing has a long history of socializing PhD students to contribute to the common good of developing new knowledge (Keller & Ward, 1993). This socialization process occurs within the context of the university as a whole. The University of Wisconsin-Madison is the flagship campus of a large, state-supported system and is ranked by the Carnegie Classification of Institutions of Higher Education as having very high research activity.
The newly developed Early Entry Option is consistent with the history and mission of the University in that it focuses on research preparation. As undergraduates, the early-entry students participate in the undergraduate honors program. They enroll in an honors seminar and, under the supervision of a faculty member, complete an honors thesis. It is during this experience that the early-entry students typically become matched with a professor. The mentor, or major professor, assumes major responsibility for the student’s research training throughout the doctoral program. The match between the mentor and student is a critical component of the enrollment process because it signals to students that a mentoring model of research training is the core of this program. In some cases, students learn during the application process that this program may not be a choice for them, either because they do not wish to become a researcher or because there is not a suitable match between the student’s area of interest and the current expertise of the faculty. In these situations, students may be advised to pursue another program or consider whether they can be more flexible about their proposed area of inquiry.
In addition to individual mentoring, the faculty mentor provides an opportunity for students to join a research group that typically meets every week. Within this context, early-entry students are able to interact with more advanced students and witness first-hand the stages of the research process and the complexity of implementing a program of research. Students also participate in a research colloquia series that exposes them to the breadth and depth of research at the University of Wisconsin-Madison School of Nursing.
Progression guidelines have been developed for each year of the program. The guidelines include benchmarks in curriculum planning (course completion, selection of mentor), progress in research (poster presentation or manuscript submission), and progression in securing funding (application for internal or extramural funding or fellowship application). The student’s progress in meeting these expectations is monitored by the student’s faculty advisor, as well as by a faculty subcommittee.
Clinical Practice Experience
The Early Entry PhD Option prepares nurse researchers with basic clinical nursing knowledge and skills and advanced knowledge and skills related to a specific clinical population. Each student is required to satisfactorily complete three of the four required undergraduate-level clinical nursing courses. In place of the fourth required clinical section, students complete an individually designed, advanced clinical experience. During the clinical practice component, students build on basic knowledge and skills, identify a population of interest, apply principles of systematic inquiry, identify gaps in clinical practice, and begin to develop a program of research. Students sit for licensure as registered nurses upon completion of the baccalaureate program; they are not expected to prepare or sit for advanced practice certification.
Recommended and Required Coursework
Programs of study are individually planned by the student and the advisory committee and take into consideration the students’ backgrounds, goals, and interests. Early in the program, there is little variation from a traditional undergraduate student’s program. Students in the Early Entry Option do enroll in an honors seminar that helps them identify their area of interest and potential research mentors. As students progress, course work is selected to support their identified areas of inquiry. Graduate course work may be substituted for undergraduate required courses. For example, early-entry students have substituted graduate-level quantitative and interpretive research courses for the undergraduate research course, thereby gaining considerable more depth in research while undergraduates. Students have also exchanged undergraduate courses for graduate-level population coursework, such as enrolling in a women’s health theory course instead of an undergraduate family perinatal course.
At the master’s level, program planning assures that students meet graduate core curriculum content as identified in the AACN (1996) Essentials of Master’s Education for Advanced Practice Nursing. When appropriate, students substitute doctoral-level work for the required core MS courses. For example, the doctoral-level role and ethics courses with a focus on preparation for the academic researcher role and research ethics may be substituted for the MS role and ethics courses focused on clinical practice. All students complete master’s-level population-focused course work. Students earning the MS degree en route to the PhD are not required to complete advanced pharmacology, advanced physiology/pathology, and advanced health/physical assessments. The MS degree is awarded upon completion of the courses indicated above, 36 graduate credits, and the minimum residence requirement by the Graduate School.
When Early Entry Option students are admitted to the doctoral program, they are well positioned to complete the doctoral program curriculum, which consists of the following curricular components: existing and evolving knowledge, methods, research ethics, teaching and learning content, course work in another discipline (PhD minor) that supports the area of inquiry, and guided research.
Early Results of an Early Entry Option
Currently, there are 10 enrolled students and 1 graduate of the program. The average age at admission of the early-entry students over the course of 5 years is 26. There is considerable difference in the average age of early-entry doctoral students enrolled in the program compared with those who are not early-entry doctoral students. Over the past 3 years, the average age of early-entry doctoral students enrolled in years 2008–2010 was 23.5, 28, and 28, respectively, compared with 41.5, 39, and 38 for those who were not early-entry students. Forty percent of the currently enrolled students are from underrepresented populations. All students have been supported with internal funds, and many have been successful in securing extramural funding; these include a federal predoctoral fellowship (National Research Service Award), Hartford Fellowship, Johnson & Johnson Fellowship, and National Institute for Nursing Research Graduate Partnerships Program Fellowship. The first person who completed the program graduated with BS, MS, and PhD degrees in just over 8 years and had six peer-reviewed publications and eight presentations to her credit.
Over the course of 5 years, it has become clearer that student recruitment and selection are complicated. We have learned to be frank and clear about the differences in the various graduate options, with the intent of not privileging one over the other, but rather encouraging thoughtful reflection on the part of the students. As a result, the attrition of the Early Entry Option has dramatically decreased.
An early entrance to PhD study has proven to be not only feasible, but also capable of producing graduates with the potential for long and successful careers in nursing research. The answer to the shortage of nurse researchers may not lie in opening new research-intensive programs, but rather in adapting the approach to doctoral education in schools that currently have a strong research tradition. A formal program evaluation of this model will be conducted to elucidate the critical elements and limitations of this program.
- American Association of Colleges of Nursing. (1996). Essentials of master’s education for advanced practice nursing. Retrieved from http://www.aacn.nche.edu/education-resources/MasEssentials96.pdf
- American Association of Colleges of Nursing. (2001). Indicators of quality in research-focused doctoral programs in nursing. Retrieved from http://www.aacn.nche.edu/publications/position/quality-indicators
- American Association of Colleges of Nursing. (2006). Nursing research. Retrieved from http://www.aacn.nche.edu/publications/position/nursing-research
- American Association of Colleges of Nursing. (2010a). The future of higher education in nursing [Annual Report]. Washington, DC: Author.
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- American Association of Colleges of Nursing. (2010c). Nursing faculty shortage fact sheet. Retrieved from http://www.aacn.nche.edu/Media-relations/FacultyShortageFS.pdf
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- American Association of Colleges of Nursing. (2011, March). Despite economic challenges facing schools of nursing, new AACN data confirm sizable growth in doctoral nursing programs [Press release]. Retrieved from http://www.aacn.nche.edu/news/articles/2011/enroll-surge
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