The Nursing School Adviser
The Nurse Ph.D.: A Vital Profession Needs Leaders

Carole A. Anderson, Ph.D., RN, FAAN Vice Provost for Academic Administration The Ohio State University

There is no doubt that education is the path for a nurse to achieve greater clinical expertise. At the same time, however, the nursing profession needs more nurses educated at the doctoral level to replenish the supply of faculty and researchers. The national shortage of faculty will soon reach critical proportions, having a significant impact on educational programs and their capacity to educate future generations of nursing students.

Although the number of doctorate programs has continued to increase, the total enrollment of students in these programs has remained fairly constant, resulting in a shortage of newly trained Ph.D.'s to renew faculty ranks. As a result, approximately 50% of nursing faculty possess the doctorate as a terminal degree. Furthermore, with many advances being made in the treatment of chronic illnesses, there is a continuing need for research that assists patients in living with their illness. This research requires individual investigators who are prepared on the doctoral level.

One reason there is a lack of nurses prepared at the doctoral level is that, compared with other professions, nurses have more interruptions in their careers. Many in the profession are females who work as nurses while fulfilling responsibilities as wives and mothers. As a result, many pursue their education on a part-time basis. Also, the nursing profession traditionally has viewed clinical experience as being a prerequisite to graduate education. This career path results in fewer individuals completing the doctorate at an earlier stage in their career, thereby truncating their productivity as academics, researchers, and administrators. To reverse this trend, many nursing schools have developed programs that admit students into graduate (doctorate and master's) programs directly from their undergraduate or master's programs.

When nurses do research for their doctorates, many people tend to think that it focuses primarily on nurses and nursing care. In reality, nurses carry out clinical research in a variety of areas, such as diabetes care, cancer care, and eating disorders.

In the last twenty years advances in medicine have involved, for the most part, advancing treatment not cures. In other words, no cure for the illness has been discovered, but treatment for that illness has improved. However, sometimes the treatment itself causes problems for patients, such as the unwelcome side effects of chemotherapy. Nurses have opportunities to devise solutions to problems like these through research, such as studies on how to manage the illness and its treatment, thereby allowing individuals to lead happy and productive lives.

Doctoral programs in nursing are aimed at preparing students for careers in health administration, education, clinical research, and advanced clinical practice. Basically, doctoral programs prepare nurses to be experts within the profession, prepared to assume leadership roles in a variety of academic and clinical settings, course work and research, students are trained as researchers and scholars to tackle complex health-care questions. Program emphasis may vary from a focus on health education to a concentration on policy research. The majority of doctoral programs confer the Doctor of Philosophy (Ph.D.) degree, but some award the Doctor of Nursing Science (D.N.S. or D.N.Sc.), the Doctor of Science in Nursing (D.S.N.), the Nursing Doctorate (N.D.), and the Doctor of Education (Ed.D.).

Doctoral nursing programs traditionally offer courses on the history and philosophy of nursing and the development and testing of nursing and other health-care techniques, as well as the social, economic, political, and ethical issues important to the field. Data management and research methodology are also areas of instruction. Students are expected to work individually on research projects and complete a dissertation.

Doctoral programs allow study on a full- or part-time basis. For graduate students who are employed and therefore seek flexibility in their schedules, many programs offer courses on weekends and in the evenings.

Admission requirements for doctoral programs vary. Generally, a master's degree is necessary, but in some schools a master's degree is completed in conjunction with fulfillment of the doctoral degree requirements. Standard requirements include an RN license, Graduate Record Examinations (GRE) scores, college transcripts, letters of recommendation, and an essay. Students applying for doctoral-level study should have a solid foundation in nursing and an interest in research. Programs are usually the equivalent of three to five years of full-time study.

Selecting a doctoral program comes down to personal choice. Students work closely with professors, and, thus, the support and mentoring you receive while pursuing your degree is as vital as the quality of the facilities. The most important question is whether there is a "match" between your research interest and faculty research. Many of the same questions you would ask about baccalaureate and master's degree programs apply to doctoral programs. However, in a doctoral program, the contact with professors, the use of research equipment and facilities, and the program's flexibility in allowing you to choose your course of study are critical.

Other questions to consider include: Does the university consider research a priority? Does the university have adequate funding for student research? Many nurses with doctorate degrees make the natural transition into an academic career, but there are many other career options available for nurses prepared at this level. For example, nurses prepared at the doctoral level are often hired by large consulting firms to work with others in designing solutions to health-care delivery problems. Others are hired by large hospital chains to manage various divisions, and some nurses with doctorate degrees are hired to manage complex health-care systems at the executive level. On another front, they conduct research and formulate national and international health-care policy. In short, because of the high level of education and a shortage of nurses prepared at this level, there are a number of options.

Salaries are related to the various positions. Faculty salaries vary by the type of institution and by faculty rank, typically ranging from approximately $50,000 at the assistant professor level to over $100,000 at the professor level. Salaries of nurse executives also vary, with the lowest salaries being in small rural hospitals and the highest being in complex university medical centers. In the latter, average salaries are well over $100,000 and often reach close to $200,000 annually. Consultant salaries are wide ranging but often consist of a base plus some percentage of work contracted. Clinical and research positions vary considerably by the type of institution and the nature of the work. Needless to say, a doctoral education does provide individuals with a wide range of opportunities, with salaries commensurate with the type and level of responsibilities. Are there opportunities to present research findings at professional meetings? Is scholarship of faculty, alumni, and students presented at regional and national nursing meetings and subsequently published? Has the body of research done at a university enhanced the knowledge of nursing and health care?

Many schools offer nursing courses online, and in some places, the entire baccalaureate and master's programs are available through distance learning. The largest enrollment in nursing distance learning is in baccalaureate programs for RNs. Distance learning allows RNs to further their education no matter where they live. Many nurses prefer online courses because they can learn at times convenient for them, especially considering competing demands associated with their jobs, families, and other commitments.