The number of nurses with research-intensive doctoral degrees is concerning. The most recent survey estimates that less than 1% of nurses have completed a doctoral degree in nursing or a related field (U.S. Department of Health and Human Services, 2010). Despite the fact that the number of doctoral (Doctor of Philosophy [PhD]) programs in nursing are increasing (American Association of Colleges of Nursing [AACN], 2012a) and that the number of students enrolling in these programs has been steadily increasing (Fang, Li, & Bednash, 2012), the number of new graduates with research-intensive doctoral degrees has remained relatively constant over the past 5 years (Fang et al., 2012). These facts have led leaders of thought to question how future needs for faculty in research-intensive academic institutions will be met.
The lack of an increase over time of the number of nurses with research-intensive doctoral degrees is compounded by several factors. One factor is the age at which nurses complete doctoral study. On average, graduates from nursing doctoral programs are aged 46 years (AACN, 2010a), compared with 33 years, which is the median age of all other doctoral awardees (Bell, 2009). This is because the typical age of an assistant professor in nursing is 52 years, nearly 20 years older than assistant professors in other disciplines (AACN, 2012b). Another contributing factor to the limited number of doctorally prepared nurses is the matriculation pattern of nurses. The median time from completion of a master’s degree to admission to a doctoral program in nursing is 15.9 years, compared with 8.5 years in other disciplines (AACN, 2010a). This longer trajectory is a function of stopping out between degrees and pursuing part-time rather than full-time study (U.S. National Research Council, 2005). Beginning doctoral study later in life and progressing more slowly through the PhD program results in graduates who have a shorter period in which to make significant contributions to the field. Another consequence is that expected retirements threaten the already small supply of faculty available to prepare future nurse researchers (AACN, 2012b).
The lack of sufficient numbers of graduates from research-focused doctoral programs in nursing has received the attention of nurse leaders. The AACN task force on the preferred future of PhD education in nursing was charged with exploring and establishing programs that more rapidly transition students from the baccalaureate or master’s entry-level degree to research-focused doctoral programs in nursing (AACN, 2010b). The baccalaureate-to-PhD degree option was identified as one educational pathway that might produce younger nurse faculty and scientists. These programs admit students to doctoral education after completion of the baccalaureate degree and are often referred to as fast-track PhD programs. Several descriptive reports (Bond, 2009; Williams, 2007) provide useful information about the opportunities and challenges of postbaccalaureate-to-PhD programs. However, documentation of age and time to degree for baccalaureate-to-PhD students is lacking. Another pathway that seeks to fast track nurses to the PhD graduate is the accelerated degree option. Scherzer, Stotts, and Fontaine (2010) described a program that allows post-master’s graduates to earn a PhD in 3 years. Although this option shortens the time to degree completion, it fails to address the remaining length of time that graduates have to contribute to the field. Scherzer et al. reported that the age range at admission of the first two accelerated option cohorts was 28 to 58 years, with the majority of individuals being 40 years or older. Thus, no evidence exists that either of the fast-track options have changed the pattern of PhD students in nursing being significantly older than their counterparts in other disciplines.
An option that could have an impact on the number and productivity of future nurse researchers is a very early entry to PhD study. Recruiting and enrolling students before or while they are baccalaureate students or immediately upon graduation provides a younger pool of students than the current fast-track options. Prebaccalaureate entrance and entrance immediately upon graduation are designed for undergraduate students who are interested in pursuing academic research careers in nursing. A key component of the early-entry option is continuous, intensive research training with established nurse faculty researchers. A more complete description of the prebaccalaureate early-entry option has been reported by Nehls and Barber (2011). To our knowledge, only three other prebaccalaureate-to-PhD nursing programs exist in the United States.
Recently, a comprehensive evaluation of the early-entry option at the University of Wisconsin-Madison School of Nursing has been completed with funding by the Robert Wood Johnson Foundation. The Robert Wood Johnson Foundation has a long history of addressing the challenges that face the nursing profession. One of their initiatives, Evaluating Innovations in Nursing, supported assessments of interventions that promote faculty recruitment and retention. The Evaluating Innovations in Nursing projects aim to increase the nurse workforce by evaluating strategies that address the nurse faculty shortage and disseminating successful outcomes for widespread replication. As one of five projects selected to participate in this initiative, the authors’ goal was to better understand how to recruit and retain PhD students early in their nursing careers.
The results are summarized according to the major topic areas of the interview: career decision making, facilitators, and challenges related to being an early-entry PhD nursing student. The findings highlight the unique experiences of students who enter a PhD in nursing program while matriculating as undergraduate students or recent baccalaureate graduates. An understanding of their experiences can lead to refinements and expansion of early-entry PhD nursing education.
Career Decision Making
For the current study, participants’ decision to enter a PhD program during or immediately after baccalaureate education was associated with two factors: (a) early and positive involvement in research activities and (b) recognition by a faculty member as being a promising PhD student.
Many of the participants recalled their involvement in research activities as being very important in their decision making about PhD education. One participant reflected on her early, “hands-on” involvement in research activities:
I took quite a few science courses in college. I liked research. And I liked people, so I thought I should go into nursing. But I wasn’t sure. Then I started in the honor’s program. I really got serious about research. My first clinical, or my second clinical, I was really, really interested in patient care, and I was interested in the research area. So my clinical instructor set me up with a research experience. I got close to research, and I was in the honor’s program, and I was working with a professor, and I was kind of doing my own study.
The participant also vividly recalled being chosen by a faculty member as a desirable candidate for early entry to the PhD program. Prior to being approached by the faculty member, the participant had not seriously considered this career path. She commented further:
It [my decision to pursue a PhD] was very serendipitous. My professor and I met outside of a bathroom. It was just weird. She was telling me that she thought maybe I should go on, right on to the PhD. I was thinking I’d have to go down the same road as everybody else did, work for several years on a hospital floor, get your master’s degree, maybe go on for a PhD, or maybe wait awhile. It wasn’t completely on my radar to do the PhD right away.
Another participant also noted that positive experiences with the research process as an undergraduate student was a key factor in her decision to pursue a research-focused doctoral degree. She stated:
The last semester prior to admission I had an intro gender and women’s studies course. It ended up being research intensive. And that’s what made me consider the early-entry program. Initially I thought I was going to end up doing primary care in a clinic to get some experience prior to being an NP [nurse practitioner]. But, the research option, I guess the research early on in my undergraduate career, is what tilted me.
These participants, as well as others, suggested that one avenue to increasing enrollment in PhD programs is to engage undergraduate students in research activities. Hands-on experiences were especially meaningful to these participants. In addition, the process of being informed about and selected for early admission to a research-intensive PhD program was a powerful influence on whether undergraduates began doctoral study early in their education.
The participants were also asked to comment on their long-term career plans. The findings confirm that the goal of preparing students for research-intensive academic careers was embraced by the majority of the students who were matriculating or had completed the program. Most of the participants’ career plans were to complete postdoctoral fellowships and subsequently obtain faculty positions in research-intensive universities. One student said:
I was hoping that I would become a professor and do teaching and research. I would teach at a school of nursing, at a university, similar to [this one]. I would do a lot of research and also teaching, working with nursing students and helping them to become better nurses or teachers.
This was echoed by another participant:
I hope to do a post-doc…and then I want to get a tenure-track position in an R1 [research intensive] institution. So that’s the track that I’m on. I do very interdisciplinary work, and I don’t think I’d have those opportunities available, outside of an R1 institution. That’s my professional goal. That’s why I’m spending all these years doing this. I have to be a recognized expert and a recognized scholar, and I need to be in a R1 tenure-track position to do that, I think.
The findings suggest that graduated and matriculating participants were very clear about their career trajectory. For many, the research-focused doctorate was the first step in assuming a professorial role at a research-intensive university. For several, there was an intention to focus on conducting research in a setting outside of academe.
Recruiting and retaining students for PhD in nursing study is an important issue for the future of nursing. Understanding the facilitators and challenges of the early-entry PhD in nursing experience can illuminate strategies for increasing the number of applicants and graduates.
The assurance of financial support was critical for most students beginning PhD study as undergraduates. Participants discussed how they actively looked for institutions that were able to offer funding. For some participants, schools that could not provide significant funding were not pursued. One participant explained her situation:
Scholarships definitely affected my decision to enroll. Knowing that I would have funding definitely was a deal maker for me. If I wasn’t able to have funding, I likely would have applied to other programs where I would get funding. Or maybe, for a few years, wait, and save some money, instead of going straight from undergrad.
The availability of funding for doctoral study cannot be overemphasized. This participant reflects on her decision to matriculate as a baccalaureate-to-PhD student. For her and many other participants, the availability of financial support made the early-entry PhD option possible and appealing:
I was so well taken care of…that was an incentive, too, for the program. I’m not sure if I would have done it without the funding. And so, without money to defray the cost of living, I’m not sure if I would have or could have done it while I was still an undergraduate. I had funding from the X [funding agency]. And then, during the summer, I had a research assistantship. And then, while I was a senior in the nursing program, I had already submitted my first F31 application. I got funded in that first round.
Another participant expanded on the notion of funding, not only as an essential practicality but also, an important personal message of commitment from the school:
I would only have selected a school that told me, very clearly, that they were going to invest in me and see me through to the end. And this was very clear in conversations that I had with people and interviews for the early-entry program. They made it very clear that they would support me. There’s this feeling about being heavily recruited, and then, being kind of recruited. Like, you could come here versus really, come here, we got you, we want you, we think you’re great!
The interview data suggest that the ability to offer financial support to students is critical to developing and sustaining entry to the PhD program as undergraduates. Without external funding, most students felt the need to seek gainful employment for a period of time before returning, if at all, to graduate school.
The participants also identified the challenges of being an early-entry student. As students progressed seamlessly from baccalaureate to doctoral study, they became concerned about a relative lack of clinical experience. For example, one participant said:
I think that it is a really key thing and takeaway message for nursing faculty designing these types of programs. It’s very clear to me that there is this sort of fake nurse syndrome that sometimes I still suffer from. That’s what we’ve called it, where it’s like, ‘I’m a nurse, but I’m not a nurse.’ And I think there’s this feeling, the fake nurse thing, feeling like you’re clinically competent. And I still struggle significantly with that one. My clinical knowledge is so inferior because I have focused so heavily on research, and on methodology, and on statistics. …The goal of our program is to train people to be scientists. I think that’s actually the major issue with this program model.
The perceived lack of clinical preparation was reiterated by another participant:
I would say, one of the things that I found myself yearning for as an early-entry student was clinical. Coming right out of my bachelor’s into the doctoral program, I wasn’t really given any opportunity to work as a nurse, outside of the clinical hours that were required of me in school. I was under the assumption that maybe clinical experience would be built into [the program]. With the early-entry program, I’m not required to work as a nurse, I could obtain my PhD, and go teach nursing students at a school, and have never set foot in a hospital as a registered nurse. And I think that’s all kind of scary because, if I’m the one who is supposed to be the authority in the room and I don’t really have any clinical experience, outside of what was required from me in school, who am I to tell you how to do things? I’m hoping, maybe in the future, that maybe internships or clinical opportunities could be built into doctoral programs, especially for the early-entry students. Whereby, students maybe have an 8 to 20 hour-a-week internship and they’re getting credit for it, where they’re going to a client, going to a hospital, doing home care, choosing to work clinically, so that they can get that experience as a registered nurse. And I feel like not only will it help them fulfill any wants or needs if they have to work as a clinical nurse, but it might also help them to tailor their research question and to work at different clinical problems from a different perspective and a different angle, to actually see what’s really going on out there and what may be wrong, and to find an area where they might be able to contribute.
For some students, the lack of clinical experience was a major factor in their decision to withdraw from the PhD program. One participant provided this reason for dropping out:
I quickly decided that there is no way I can do nursing research unless I’d been a nurse. Because you have really no idea what is really going on, what it’s like. I just couldn’t imagine, unless you were somebody’s assistant and somebody else is guiding the research. I have to be a nurse first if I want to do this.
Another participant expressed the following similar point of view:
I felt like I didn’t know or understand nursing well enough to do nursing research. I understood research, but I didn’t understand nursing research. I felt like I needed more nursing experience.
Although students entered the early-entry PhD program because of an interest in research, they nonetheless expressed a need to graduate with a sense of clinical competence. According to them, this was challenging, given the strong research focus of the early-entry PhD option. For some, the clinical component of the program was insufficient and prompted them to withdraw.
The current practice of primarily enrolling postbaccalaureate and post-master’s students is not producing an adequate number of graduates who can make significant and sustained contributions to nursing research. A younger pool of students is needed. At the University of Wisconsin-Madison, a comprehensive evaluation of early entry to the PhD in nursing program has been completed. The evaluation, funded by the Robert Wood Johnson Foundation, has produced important conclusions about student recruitment, financial support, and curricular components.
This project provided useful information about how to recruit younger and more diverse students to PhD in nursing study. One lesson learned is that undergraduate students have little awareness about PhD study in nursing. Students are initially attracted to nursing for conventional reasons—a desire to help people, a family history of being a nurse, a fondness for science courses. However, nursing must question why—Why doesn’t a PhD in nursing occur to young people as a likely and attractive occupation? An obvious answer is that exposure to PhD-prepared nurses is rare, given that less than 1% of nurses have a PhD degree. For this reason and others, leaders in nursing must create and expand on making visible the options for doctoral study in nursing. In this regard, national media attention can be a powerful recruitment tool. On a local level, information about PhD study must be accessible and appealing to young students. More efforts at all levels are needed to increase awareness of early-entry PhD in nursing options.
A second lesson learned is that early and positive experiences with research can make a difference in the decision to pursue a PhD degree. The experiences that are particularly valuable seem to occur outside of the required research courses and are distinguished by having hands-on work. Like clinical practicums, students become excited by becoming a part of the research process and not simply reading or attending lectures about research. Evaluation of approaches to engage students in research support this view (Cepanec, Clarke, Plohman & Gerard, 2013; Kennel, Burns, & Horn, 2009). Schools of nursing with high research activity levels are able to provide an honors program or other independent opportunities for undergraduate students to work with faculty and postdoctoral fellows or doctoral students. Schools that do not have research productivity as an emphasis are challenged to find alternative resources in other areas of academe or outside of academe. Regardless, a necessary step in interesting undergraduates in research training is changing or strengthening the view that research activity is a priority in undergraduate nursing education.
Finally, the current study demonstrated that nursing faculty have considerable influence in increasing the likelihood that undergraduate students will enroll in PhD programs. The process of appointing a prospective student must be embraced and expanded by both clinical and research faculty if nursing is to reach the goal of doubling the number of doctorally prepared nurses by 2020 (Broome, 2012). In addition, schools of nursing need to consider how to increase opportunities for interactions between undergraduate students and research-focused faculty. This could take the form of directly admitting freshmen to the nursing major, increasing the proportion of research faculty teaching undergraduate courses, and expanding faculty development around mentoring undergraduate students for PhD study. In all cases, there must be a school-wide investment in facilitating students’ interest in the role of the PhD-prepared nurse.
For the early-entry participants, the internal and extrinsic drive to seek a PhD degree led to the next step—is it possible? These participants made it clear that without funding they would have delayed or perhaps foregone doctoral study.
Currently, a variety of mechanisms to support doctoral education exist. At the federal level, there are institutional (National Institutes of Health [NIH] T32 Research Service Awards) and individual (NIH F31 Research Service Awards) predoctoral fellowships, funding from faculty research awards (NIH RO1 Research Project Grant), and traineeship and loan funds (e.g., Advanced Education Nursing Traineeships, Nurse Faculty Loan Program). The institutional predoctoral fellowship (T32) is an excellent source of funding and offers a potentially enriching training model. However, the institution’s ability to secure a T32 training grant award is linked to the existence of a strong research record of its faculty. Students also have the option to seek independent funding through the institutional predoctoral fellowship (F31) program. This is an excellent funding source for students who have developed a research focus and have been sufficiently mentored in research. Faculty’s individual research funding, such as RO1 awards, can also provide a means of recruiting and funding doctoral students. However, the number of schools that offer PhD in nursing programs and have RO1-funded researchers is disproportionately small. Another federal program, the Nurse Faculty Loan Program, provides loans to students who agree to and are interested in assuming a faculty position upon graduation. In addition to federal and state financial aid programs for graduate nursing students, numerous funding options are available through private organizations and specialty-focused agencies. For example, the Johnson & Johnson Campaign for Nursing’s Future–AACN Minority Nurse Faculty Scholars Program provides annual scholarship funding to individual graduate students from minority backgrounds who agree to teach after graduation, and the National Hartford Centers of Gerontological Nursing Excellence offers pre- and postdoctoral scholarships for graduate students specializing in academic geriatric nursing. Given that funding is a critical factor in whether students will enter as undergraduates and seamlessly progress through doctoral education, nurse leaders must consider and act on ways to increase funding options and amounts. If funding is not available, students are likely to stop after earning the baccalaureate, seek competitive employment, and return to study later or on a part-time basis.
Regardless of whether funds for PhD study are from federal, private, or internal sources, a clear commitment of early and continuous support must be apparent. Applicants want and, in some cases, need to hear that financial support is available. The message not only must contain a promise of money for beginning PhD students but also must communicate the underlying idea that faculty value their potential as scholars. Both factors highlight the need for effective communication about financial support via Web sites, print material, and personal interactions.
In addition to student recruitment and funding, the current study provided useful information about the curricular components of an early-entry PhD program option. The one area of the curriculum on which participants consistently commented was clinical experience. Enrolled and graduated students expressed a concern about being clinically competent, and many of those who left the program cited a preference for clinical work, rather than research, as the major reason for leaving. In either case, the participants provided recommendations about how to address students’ desire for more clinical experience. Some participants suggested including additional required clinical coursework, particularly at the advanced level; others thought that a residency or boot camp following undergraduate study would be helpful. Some of the participants were able to find part-time employment as RNs, whereas others did not. Those who were employed part time found it to be helpful from a clinical and research perspective but felt that their decision was not supported by the faculty.
The amount of supervised clinical experience in undergraduate nursing curricula is a long-debated issue. Consideration of various perspectives of the debate is warranted to improve this early-entry program and offer suggestions for new program development. On one hand, there is a tendency to heed the recommendations of participants and require more clinical experience in the early-entry PhD option, but there is also an inclination to uphold the research focus of an early-entry, research-focused PhD program. Instead of trying to resolve the tension by choosing one position over the other, both views might be addressed. Early-entry, research-focused programs could have available a menu of clinical options. Some students may decide to avail themselves of additional and more advanced clinical experience, whereas others may not. In either case, the option may serve to increase enrollment, decrease attrition, and improve student satisfaction with early-entry PhD in nursing programs.