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Doctoral Degree Preferences for Nurse Educators

Findings From a National Study

King, Tara Spalla PhD, RN; Melnyk, Bernadette Mazurek PhD, RN, APRN-CNP, FAANP, FNAP, FAAN; O'Brien, Tara PhD, RN, CNE; Bowles, Wendy PhD, RN, APRN-CNP, CNE; Schubert, Carolyn DNP, RN-BC, CNE; Fletcher, Linnea EdD, RN, CEN, TCRN; Anderson, Cindy M. PhD, RN, APRN-CNP, ANEF, FAHA, FNAP, FAAN

Author Information
doi: 10.1097/NNE.0000000000000730

Abstract

Nurses interested in educational careers in academic or practice settings are increasingly expected to have doctoral preparation, consistent with the national call to double the number of doctorally prepared nurses by 2020.1 Current doctoral degree options most closely aligned with the career trajectory of nurse educators are the doctor of philosophy (PhD), doctor of nursing practice (DNP), and doctor of education (EdD). The PhD prepares nurses to pursue careers in research/science, generating new knowledge to inform practice and policy in real-world clinical settings.2,3 PhD-prepared faculty, representing 8% of nursing faculty overall,4 disseminate groundbreaking evidence to advance the field and mentor the next generation of nurse scientists. Consistent with the primary emphasis on generation of new knowledge, emphasis on principles of teaching and learning is limited in PhD education, suggesting that PhD-prepared faculty in teaching-intensive settings may not have the depth of preparation needed for the role.5,6

The DNP degree prepares nurses to rapidly translate evidence into practice and policy2 in direct and indirect care roles, with emphasis on leadership, evidence-based practice, and systems improvement.7,8 DNP-prepared nurses comprised 20.3% of nursing faculty9 in 2018 and increasingly represent the cadre of expert practitioners who teach in academic and practice settings.7 Since the DNP was conceived as an advanced practice degree, emphasis on teaching and learning is similarly limited, suggesting that DNP-prepared faculty in teaching-intensive settings face similar challenges as PhD-prepared faculty when assuming the role of nurse educator.

The EdD largely prepares individuals for administrative roles across disciplines, predominantly in K-12 and higher education.10 Representation of professionals across a variety of disciplines is both a strength and limitation of EdD programs as the emphasis is on administration, leadership, research, and pedagogy but not nursing focused and may not support adequate preparation for nurse educators in clinical and academic settings. While there are a small number of faculty with the EdD in nursing education programs in the United States, on investigation of their curricula, much of the content is not specific to the practice discipline of nursing. Less than 7.1% of nursing faculty have an EdD.9

A number of master's-prepared nurses seek terminal degrees in preparation for a career in nursing education. The mismatch in career aspirations and current terminal degree options leaves those with an interest in nursing education without an ideal educational program focused on leveraging their disciplinary expertise and preparation for educator roles in academic and practice settings. Potential options include selection of an existing terminal degree that does not fully meet their needs or the decision to forego doctoral education entirely. Little is known regarding the need for, and interest in, a terminal degree designed uniquely to prepare nurses for a career in nursing education. Therefore, the purpose of this study was to determine the perceived adequacy of current terminal degree options for nurse educators.

Literature Review

The current faculty vacancy rate is 10.4% with positions requiring an earned doctorate encompassing the largest percentage of that vacancy at 56.1%.11 When compounded by the increasing average age of current nurse educators, 72% of which are older than 50 years,4 there is an urgent need for nursing educator workforce development.

Bagley et al12 conducted a qualitative descriptive study of master's-prepared RNs not working in academia to uncover barriers preventing transition to the nurse faculty role. Perception of the academic educator role and needing more “academic instruction, including curriculum design, test item writing, teaching methods, evaluation, and research methods”12 were major themes about perceived barriers as well as a need for a doctoral degree. A recent study conducted with 843 DNP students found 32% (n = 271) planned to pursue faculty careers after graduation.13 Interest in a faculty role in a study of students and graduates in a DNP program (n = 172) indicated that 38% pursued the DNP with a career goal of teaching.14 Participants reported that 29% were employed full-time in an academic position.14 The absence of opportunities to develop teaching expertise in DNP and PhD programs was a concern of students and graduates in a study by Dreifuerst and colleagues.15

Although many students in doctoral programs express a desire to have teaching-learning content and practicum experiences to prepare them for a faculty role, a teaching practicum is required by only 20% of PhD in nursing programs16 and 5% of DNP programs.17 Further, while the terminal degree in nursing is a gateway to college teaching, nurse educator practice hours are ineligible for inclusion as DNP practice hours, requiring supplemental coursework to prepare for, seek, and obtain a faculty position.18 The American Association of Colleges of Nursing (AACN) acknowledges that the DNP degree does not prepare graduates for the educator role and recognizes this as a limitation, although such preparation does not preclude graduates from a faculty appointment.18

There is a need to develop a cadre of highly qualified nurse educators, skilled in the practice of teaching, to prepare new nurses to enter the workforce as soon as possible. Decreased access to care is a serious public consequence of the bottleneck in nursing education from a lack of nurse educators to meet the need of preparing adequate numbers of nursing graduates. It is anticipated that we will not be able to keep up with demand for nurses to provide health care despite the hard-fought growth in enrollment due to impending baby-boomer nurse retirement. The number of nurses leaving the workforce each year has been growing steadily from approximately 40 000 in 2010 to nearly 80 000 by 2020. Meanwhile, the dramatic growth in nursing school enrollment over the last 15 years has begun to level off.19

A viable solution to the need for well-qualified doctorally prepared nurse educators is a terminal degree that prepares expert nurse educators in application of pedagogy and best evidence in nursing education, leveraging preparation with clinical expertise. A proposed doctor of nursing education (DNE) degree could provide an option for nurses who desire to pursue a terminal degree aligned with their teaching-learning goals. The DNE degree could provide a pipeline of educated expert nursing faculty in academia as well as professional development specialists in health care.

Methods

A descriptive survey design was developed by the authors for distribution to nurses in practice, academia, and leadership. Institutional review board exempt status approval was obtained for this study. The survey was developed as a needs assessment. The convenience sample comprised members representing 2 national Listservs, the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare and the Quality and Safety Education for Nurses Institute. These 2 Listservs were selected because of diversity of membership across multiple demographics including age, education, practice specialties, leadership roles, and location in the United States and included both military and civilian nurses.

Methods included email communication about the survey that was sent to these Listservs, explaining the purpose of the study and inviting them to participate anonymously in an online survey. The survey contained 5 demographic items (age, highest level of education, current job title, current enrollment in terminal degree program, and type of program). There were 8 Likert-style items focused on perceived adequacy of nursing faculty workforce; focus of current DNP programs; and adequacy of current doctoral degrees sought by nurse educators related to content in best practices of teaching-learning in nursing, curriculum design and development in nursing education and clinical practice, and nursing education assessment and evaluation, all with a response set of 1 = strongly disagree to 5 = strongly agree (Table 1). One item included a categorical yes or no response: Would you be interested in obtaining an online DNE degree that is parallel to the DNP degree with a similar number of credit hours? There was a follow-up item asking respondents to explain this response. One item enlisted feedback: In a DNE degree, what do you believe would be the most important courses/content to offer? The final item was open response to capture any further insights. All items were optional. The questionnaire was anonymous and required 5 minutes to complete.

Table 1
Table 1:
Doctoral Education Survey

Data were analyzed using descriptive statistics for the demographics and Likert-style items. Content analysis of word frequency was used for the open-ended questions to identify common themes. Data were sorted and grouped by exact words, phrases, and synonyms. Various interpretations were examined within the context of the entire entry and survey before conclusions were made for overarching themes. Two of the authors analyzed the data to identify common themes, resolved discrepancies, and arrived at consensus.

Results

A total of 826 nurses across the United States responded to the survey (response rate, 27%). Respondent age ranges (rounded to the nearest whole number) were as follows: 20 to 29 years (1%), 30–39 years (12%), 40 to 49 years (22%), 50 to 59 years (35%), 60 to 69 years (27%), and 70 years or older (2%). Most respondents (63%) were between 50 and 60 years of age, and 44% had a master's degree in nursing. Nurses prepared with DNP and EdD degrees represented 14% and 2% of the respondents, respectively (Figure 1, Supplemental Digital Content, http://links.lww.com/NE/A662). Ninety-five of the respondents (12%) were currently enrolled in a terminal degree program: 49% DNP, 28% PhD in nursing, 16% terminal degree program other than those listed, 4% EdD, and 2% PhD non-nursing program (Figure 2, Supplemental Digital Content, http://links.lww.com/NE/A663). Respondent job titles were broad in scope, included both academic and practice settings, and represented employment in civilian and government environments. The most common categories of job titles included leaders and faculty in academia, leaders in practice and practicing nurses, clinical educators, and leaders and members of national health care and nursing organizations.

Participant responses indicated perceived inadequacy of the nursing faculty workforce. Most respondents (78%) believed there is a shortage of nursing faculty who are prepared with a PhD or DNP. Nearly half (44%) believed nursing faculty who do not have a doctoral degree (eg, PhD or DNP) pursue a DNP to continue teaching. Almost three quarters (72%) agreed the DNP degree was intended to prepare graduates to rapidly translate research evidence into clinical settings to improve outcomes at the highest level.

Best Practices of Teaching and Curriculum Development in Nursing

Survey respondents reported current doctoral degrees sought by nurse educators lack content related to best practices in teaching-learning in nursing (64%) and curriculum design and development related to nursing education and clinical practice (65%). Further, 60% expressed a lack of content in nursing education assessment and evaluation (Table 1).

When asked which content areas would be desired in a proposed DNE degree, respondents identified 14 top content areas, often with the adjective “advanced” (Table 2). Guidance for further development of a new terminal degree was based on qualitative feedback, including suggested content areas and considerations of possible long-term implications, both positive and negative. Themes emerged from the participants' responses. Saturation was reached in the first quarter of respondents; however, all data were considered and included.

Table 2
Table 2:
Most Frequently Suggested Topics for DNE Curriculum

Themes and Representative Quotes About Proposed DNE Degree

The themes included need for content related to nursing education: “I believe this degree would be the best of 2 worlds. The EdD program does not touch nursing and allow me to incorporate what I do. I am not a school teacher, and they push heavily on that part of the curriculum”; current terminal degree programs do not fill the needs of faculty or nursing professional development practitioners: “Not interested in a PhD or DNP for my position. There should be a doctorate program specific to nurse educators that pertains to their daily job” and “Education like clinical practice is a separate skill set that has a unique set of needs. By virtue of having a DNP or a PhD does not prepare you to be an educator”; desire support for further role development and to speak to my passion for nursing education: “I would be interested in a doctoral program geared toward education rather than nursing practice. This is the reason why I have not enrolled in a DNP program. I love teaching and… need a program that will give me more tools to continue that mission”; chose DNP, but it does not fill passion or need. It was best option at the time: “I feel caught in the middle at times. I have a DNP, and it prepared me for translational research, health care policy influence, and improvement strategies. The DNP did not particularly support taking my MSN Ed to the next level.”

Other themes were related to public perception: “I think we need to be careful about creating 1 more terminal degree—this would look like DNPs and PhDs are not prepared at the highest level to teach nursing. I think educators should complete the Nurse Educator Certificate program in addition to a DNP and/or PhD”; dilute the profession: “I disagree with creating additional terminal degrees. If information is sought on curriculum design and evaluation methods, the recommendation should be to pursue an EdD. This continues to dilute the terminal degree for nursing”; concern about compensation: “Education is an unappreciated and not adequately or fairly compensated” and “Universities will have to see the DNE as a terminal degree and provide equal pay before nurse educators will ever pursue the degree.”

Discussion

In examination of the qualitative data from this survey, it appears that nurses have different perspectives about the need for another terminal degree in nursing. There were a few respondents who were neutral about the subject; nurses either supported the idea with statements such as “this is needed” or were against it with concerns such as “diluting the profession.” Survey data demonstrated the need for a new terminal degree in nursing education for individuals who desire to be experts in the practice of teaching in nursing.

Several respondents shared that their coursework in their PhD, DNP, or EdD programs met their goals in becoming expert nurse educators. Others stated that they did not pursue a terminal degree because a PhD or DNP would not meet their needs for advanced preparation in nursing education.

Some respondents expressed concern about launching another nursing degree. Others suggested unmet needs in current terminal degree options could be met by taking additional coursework in an add-on fashion nursing education. However, this approach is typically not attractive to students concerned about additional time and expense and the return on investment. It also requires students to be forced into a degree inconsistent with their goals and aspirations. This strategy can be particularly unappealing for faculty in institutions that do not value the practice of education in their promotion and reward structures, regardless of whether these values are espoused.20

Other respondents suggested adding a minor to the PhD or DNP degrees to encompass nursing education or developing a post–master's nursing education certificate program. In a survey by Aquino et al,21 respondents who recently completed a PhD or a DNP and had been working less than 4 years in academia were asked about teaching preparation in their programs. The majority of respondents (59%) did not have coursework to prepare them for an educator role. The addition of a few courses within a PhD or DNP program cannot encompass the body of evidence-based practice related to didactic and clinical teaching that needs to be infused into nursing curricula for those nurses who want to be experts in nursing education. Just as research is the central focus of the curriculum of PhD programs and translating evidence into real-world practice settings is the central focus of DNP programs, education theory and principles, curricular content, and assessment and evaluation with specific application to nursing should be the core curricular focus to prepare experts in nursing education.

Research suggests there is a continuum of factors influencing student completion and success, including learning environment, integration into academic culture, engagement, self-efficacy in academic ability, and faculty interactions. Faculty development and increased ability to teach result in improved student learning and outcomes.22 While thoughtful and intentional pedagogy underpinning success in the classroom is predictive of graduation, evidence-based practices are often not applied23 but could be a part of DNE curriculum. Nurse educators may decide not to teach in the clinical setting because of a lack of knowledge to teach in both academic and clinical settings.24 The DNE could prepare students for application of best practices in teaching-learning in academic and clinical settings with sound pedagogical, theoretical, and discipline-based foundations, resulting in improved instructional quality and outcomes for educational and health care environments.

The development of a separate education track in the DNP program is not congruent with AACN criteria, suggesting education represents a unique discipline separate and distinct from nursing: “The task force reaffirms that ‘the discipline of education encompasses an entirely separate body of knowledge and competence’25 and is not an area of advanced nursing practice.”18 Therefore, any additional coursework related to nursing education would be considered optional and supplemental to the DNP curriculum.18

Although some respondents expressed concern about an added degree leading to decreased enrollment in PhD programs, many individuals who enter PhD programs do not plan to develop a sustainable program of active research if their objective is seeking the degree as a requirement for a teaching-intensive faculty position. Nurses who desire to be rigorous researchers should be encouraged to enter these programs, and PhD-prepared nurses with active programs of research should be the faculty who are teaching students in these programs. Yet, many faculty members with PhDs do not have active research programs, as they obtained the degree primarily to enter academic teaching positions. It does not help the profession to guide people to pursue the PhD path if they do not desire to be in an active research role. Lack of PhD enrollment is a separate issue to be addressed through aggressive recruitment, marketing, and communications initiatives, highlighting the tremendous positive impact researchers can have on improving health care quality and population health outcomes.

The DNE could fill an unmet need for individuals who choose not to enroll in a terminal degree program because current options do not fit their career goals. Alternately, the DNE may attract those who would have selected a DNP because they wanted to teach rather than conduct research.

The majority of survey respondents believe that there are not enough nurse educators with terminal degrees and that current degree options for nurse educators do not meet the perceived need related to content and skills. Aggregate survey data indicated that respondents agreed that developing a nursing education degree is needed to address content related to (1) best practices in teaching-learning in nursing, (2) curriculum design and development related to nursing education and clinical practice, and (3) nursing education assessment and evaluation.

Doctorally prepared nurse educators are needed to facilitate the rapid translation of robust research into evidence-based practices of teaching-learning in nursing education26 and such practices should be included in the DNE curriculum. The DNE degree could meet current and future faculty need and ease the bottleneck, producing more nurse graduates across degree levels, resulting in increased access to health care.

Limitations

As with many surveys, the way certain questions were asked might have encouraged some participants to respond in a certain way. Our sample was obtained from only 2 large nursing email Listservs in the United States and was not a random sample, which limits generalizability. Despite this limitation, we obtained a large sample size of nurses from many areas across the nation.

Conclusions

As a profession, it is important to stay abreast of population trends, including workforce shifts such as retirement and resultant need for nurse educators to maintain or improve access to health care. Current terminal degree options are not aligned with perceived needs of master's-prepared nurse educators in academia and professional development settings who seek the highest level of knowledge and skills in teaching-learning. It is time for innovative thinking and problem solving. A DNE degree may be part of the solution.

References

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Keywords:

doctoral nursing education; faculty; needs assessment; nurse educator preparation; nursing education

Supplemental Digital Content

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