PhD-Prepared Nurses' Areas of Inquiry

Abstract

Background: 

Nursing science is heavily dependent on nurse scientists with adequate funding. Nurse scientists should be aware of organizations' research agendas and, to the extent possible, align research with stated research priorities. Current information on the demographics of nurse scientists, their projects, and the alignment to known priorities is illusive.

Purpose: 

To describe areas of inquiry pursued by PhD-prepared nurses and congruence with the research agendas of nursing organizations.

Methods: 

A descriptive, exploratory approach was undertaken with PhD-prepared nurse scientists to gather data about their PhD program, dissertation topic, current work status, productivity, and future recommendations.

Results: 

Key findings were that dissertation topics were broad and aligned with research priorities. Elements influencing research productivity are described.

Conclusions: 

Understanding current nursing science stewardship and intentionally strategizing for the future of research, academia, and clinical practice will enhance our ability to tailor PhD programs accordingly.

The landmark 2011 Institute of Medicine Future of Nursing report recommended a transformation of the nursing profession in the realms of practice, education, leadership, and workforce data, and advocated doubling the number of nurses with a doctorate by 2020.¹ In a 2016 interim report, authors evaluating the progress of the 2011 recommendations indicated findings of phenomenal growth in the number of programs, enrollments, and graduates of doctor of nursing practice (DNP) programs.^2,3 The robust growth in obtaining clinical doctorates (DNP) has assisted in reaching the goal of increasing the number of nurses with doctoral degrees by 2020. As of 2021 data, there were 40 834 students enrolled in DNP programs with 10 086 graduating.⁴ This is compared to 2021 metrics of 4476 enrollments and 733 graduates of PhD programs.⁵ Concern is raised that the numbers of nurses prepared with a research-focused doctorate are not keeping pace with the needs of the profession and society.^6,7 Many research-focused nursing programs are poorly resourced with insufficient numbers of senior faculty available to mentor students, producing predominantly descriptive studies.⁸ Greater research productivity and a more purposeful career development focus are associated with experienced leadership and mentorship of postdoctoral prepared nurses.⁹ Nurses with a research-focused doctoral degree are needed to fulfill the research priorities of funding organizations to advance the health and well-being of populations, and have the skills to collaborate on interprofessional research teams.²

Nursing research agendas are driven by an agency or organization's mission, providing research foci and the establishment of funding priorities. For example, the National Institute of Nursing Research (NINR) specifies areas in need of expansion, leading to improvements in health equity, social determinants of health, population and community health, and systems and models of care.¹⁰ The National League for Nursing (NLN) published research priorities that include expanding the science of nursing education in the areas of teaching-leaning innovation, faculty teaching practices, interprofessional education strategies, and building the nurse faculty workforce.¹¹ The Interdisciplinary Research Group on Nursing Issues of Academy Health set an agenda for nursing health services research.⁹ Nursing specialty organizations such as the Oncology Nursing Society¹² and the Hospice and Palliative Care Nurses Association¹³ also developed research agendas. However, unless one is familiar with each of these many organizations, an awareness of all the research opportunities available can be illusive.

The nation lacks a central database on all the organizations that have research agendas. What areas of research are PhD-prepared nurses pursuing? What knowledge is being generated by PhD-prepared nurses? Is the research being produced congruent with stated research agendas? Where are the gaps? What factors may have influenced nursing research output? The answers to these questions are largely unknown. Gaining insight may help raise the awareness of nurse researchers to society's most pressing health challenges.

The purpose of the study was to begin exploring metrics relating to areas of research interest, scholarly output, and other descriptive characteristics of PhD nurse scientists. Using survey methods, we sought to learn more about the type of research being conducted by PhD-prepared nurses, their scholarly productivity, and demographic/programmatic information.

Materials and Methods

This research team developed a 20-item online survey including 2 open-ended questions drawn from the literature and networking discussions at national conferences to address the study's purpose. The survey consisted of demographics, work status and setting, information about the institution and program where PhD was earned, title or topic of dissertation (open-ended), and productivity, measured by funding history and type (external or intramural) and number of publications. The second open-ended question provided participants an opportunity to include recommendations for promoting the research-focused doctorate in nursing. The instrument was pilot tested among peers prior to data collection. The institutional review board of the authors' institution deemed the study exempt.

We recruited a convenience sample of participants by providing study information with inclusion of a survey link by emailing 123 deans and program directors of American Association of Colleges of Nursing (AACN) member schools with a PhD program (listed in fall 2020), an NLN newsletter (November 30, 2020), and inclusion of a QR code on a poster presentation at a regional conference (April 2021). PhD-prepared nurses were eligible to participate. Potential participants were informed that completing the survey constituted consent.

Data Analyses

Quantitative data were analyzed with IBM SPSS (Version 26, Armonk, New York). Descriptive statistics analyses were conducted for respondents' demographic characteristics, PhD program factors, research interests and funding, and scholarly output using frequencies for nominal variables and mean with standard deviation for continuous variables. Correlational analyses were conducted using Pearson's χ² calculations to test for associations between nominal variables, and the eta coefficient test was used to test for associations between nominal and interval variables, with significance level set at P < .05. Responses to 2 open-ended questions were analyzed with NVivo (Version 12, QSR International Pty Ltd) using a content analysis approach.

Results

Participants

A total of 97 surveys were completed, with the majority of the sample consisting of White women. On average, participants were older than 50 years (mean = 54.28, SD 11.41), most worked full-time (96.8%), and were employed in nursing (98.8%). Although all respondents were PhD-prepared nurses, 4.2% did not have a PhD in nursing but in a related field.

Most participants (76.8%) had attended a public university for their PhD education, full-time (69.9%), in a fully face-to-face educational format (70.5%). Only 37.2% had been fully funded for their PhD education. On average, participants had completed their PhD in less than 5 years (mean = 4.85, SD 1.40) and had completed their PhD just over a decade prior to completing the survey (mean = 11.37, SD 9.59). The majority had published their dissertation (70.2%), and a quarter of the participants had also completed a post-doc (Table).

Table. - Demographics and PhD Educational Characteristics (N = 97)

Characteristic	n (%)/Mean ± SD
Gender
Female	90 (92.8)
Male	6 (6.2)
Nonbinary	1 (1.0)
Race/ethnicity
Asian	6 (6.2)
Black or African American	2 (2.1)
White or Caucasian	83 (85.6)
Hispanic or Latino	1 (1.0)
Other	3 (3.1)
Age at completion of PhD	43.07 ± 8.48
Years since PhD completion	11.37 ± 9.59
Current work status
Part-time	0 (0)
Full-time	92 (94.8)
Retired	2 (2.1)
Discipline in which PhD is held
Nursing	92 (94.8)
Nonnursing	4 (4.1)
University type attended
Public	73 (75.3)
Private	22 (22.7)
Educational method
Fully face-to-face	67 (69.1)
Fully online	4 (4.1)
Hybrid	20 (20.6)
Summer intensives/other	4 (4.1)
Attended PhD program full-time
Yes	28 (28.9)
No	65 (67)
Number of years to complete PhD	4.85 ± 1.40
Educational funding
Fully funded	35 (36.1)
NFLP	13 (13.4)
Personal loans	4 (4.1)
Personal savings	11 (11.3)
Employer benefits	12 (12.4)
Other	19 (19.6)
Published doctoral dissertation
Yes	66 (68.0)
No	23 (23.7)
Submitted for publication	5 (5.2)
Post-doc completed
Yes	24 (24.7)
No	68 (70.1)
In-progress	2 (2.1)
Funded research
Yes	76 (78.4)
No	18 (18.6)
Type of funding
External	52 (53.6)
Intramural	12 (12.4)
Other	13 (13.4)

Abbreviation: NFLP, Nurse Faculty Loan Program.

Current positions held were primarily academic, with individual participants often indicating more than one role. Administrative roles were noted by 13 participants and specified as dean, associate dean for research, associate dean for research and innovation, assistant dean, vice president of academics, or board of directors. Teaching roles were characterized in these ranks: 1 clinical instructor, 28 assistant professors, 18 associate professors, and 16 professors. Eight participants noted additional director, program coordinator, or department chair roles. An equal number of participants added qualifiers, noting that they were either a clinician or researcher. Role was significantly correlated with years since graduation (r = 0.454, P < .001), with more administrative roles associated with increased number of years since graduation.

Additionally, most participants had received research funding (80.9%) after completing their PhD, with 67.5% of the funding identified as external funding. Half of the sample claimed 10 or fewer publications, including participants who had obtained their PhD up to 20 years ago. Those with over 50 publications (19.1%) had all completed their PhD programs more than 10 years ago (see the Supplemental Digital Content, available at: https://links.lww.com/NE/B293).

Correlations

χ² calculations were used to test associations between nominal variables. The type of university attended (public vs private) was not significantly associated with how participants' PhD education was funded (χ²₍₅₎= 8.82, P = .113), completion of a post-doc (χ²₍₂₎= 2.23, P = .302), or number of publications (χ²₍₆₎= 6.83, P = .340). However, type of university attended (public) for PhD education was significantly associated with having funded research (χ²₍₁₎= 5.50, P < .019), though type of research funding (external or intramural) was not significantly associated.

To test strength of associations of nominal with interval variables, we used the eta coefficient test. University type was weakly associated with the number of years to complete a PhD (η = 0.225). The number of publications was strongly associated with the number of years since graduation (η = 0.734), but funding type was only weakly associated with the number of years since graduation (η = 0.203). Intramural funding was common up to 5 years after graduation, while external funding was more likely 9 or more years after graduation. Years to complete PhD education was moderately associated with the type of university (η = 0.369), with participants who attended public universities taking significantly fewer years to complete their PhD (mean = 4.67, SD 1.21) than those attending private universities (mean = 5.41, SD 1.80), t₍₉₁₎ = −2.21, P < .030, r = 0.53).

Participants' Dissertation Topics

Dissertation topics were thematically categorized with some overlap, as titles/topics could be represented in multiple categories. The top 5 categories were: (a) health disparities/social determinants of health/vulnerable populations, (b) nurses/nursing students, (c) psychosocial/behavioral, (d) symptom management, and (e) the study of chronic conditions (Figure). Other categories included disease management, acute conditions, patient/family education or experiences, physiology/pathophysiology/biomarkers, and psychometrics.

Figure.: Top 5 categories of participants' dissertation topics. SDoH indicates social determinants of health.

Qualitative Themes

Text responses to an open-ended question about recommendations for promoting the research-focused doctorate in nursing were analyzed using open coding and categorized to identify themes: (a) student needs, (b) program recommendations, and (c) PhD role awareness.

Student Needs

Funding was the most frequently expressed recommendation to meet student need. Participants did not specify type of funding needed (eg, tuition, dissertation research, and living expenses). The concern for students is exemplified in the following quote, “Lack of funding support for PhD students in nursing is a national disgrace.” Second, more opportunities for diverse students to obtain hands-on primary research experience with faculty mentorship were strongly recommended, as indicated in this participant's comment, “Ensure that funding and good mentorship particularly for minority students is available.” Participants also suggested redirecting research foci and funding to reflect younger nurses' concerns, such as climate change, environmental health, and health and wellness redefined as today's youth experience it.

Program Recommendations

Recommendations were given for every level of nursing education. Participants noted the need for undergraduate programs to prepare students for PhD education by engaging promising students in research from the start, having advisors who are well-versed in the continuum of higher education in nursing, and encouraging a post-baccalaureate to PhD trajectory.

Generally, recommendations for PhD programs included increased flexibility in format and access, strengthened mentorship, help with recruiting to increase enrollment, diversity, and more faculty. The disparity in pay between clinical practice and academe was mentioned repeatedly as a barrier to attracting students, as well as hiring and retaining faculty, as illustrated by the following comment made by one participant: “Salaries for nursing professors need to be drastically increased, or students will not pursue them. Since we are teaching the future of nursing, we should be better compensated.” Pay was emphasized as a way to explicitly value research and PhD-prepared nurses.

There were a number of specific program recommendations, most commonly pertaining to having research practicums, requiring manuscript-style dissertations, and grant writing. For example, a participant wrote, “Include writing a grant as part of the PhD program.” Participants also identified the need for more postdoctoral opportunities, and reduced teaching loads to facilitate development of nurse scientists. While there was a repeated emphasis that PhD-prepared faculty are essential in academia, concern was also expressed that PhD programs should be preparing nurse scientists, as noted in the following quote: “The focus of PhD nursing education needs to return to creating nurse scientists and not just more academic faculty.”

Across all levels of nursing, engaging students in faculty-led programs of research, ensuring rigor, and the need for administrative support of research were identified. The primacy of the need for research support is exemplified in the following participant comment, “But most importantly—administration needs to clarify how research fits into their strategic plan.” Participants expressed that deans need to demonstrate that research is as important as clinical training, promote and value the PhD as the terminal degree in nursing academe, and provide promotion and tenure criteria with rationale. Featuring the research of nurse scientists was suggested as a way to recognize faculty for their work while also increasing students' exposure to research.

PhD Role Awareness

Participants identified the need to differentiate the scope of the research-focused doctorate from a clinical doctorate, and promote the many career options, emphasizing the versatility of PhD-prepared nurses. This sentiment was expressed by a participant's comment, “Increase advertisement of the benefits of being a scholarly nurse.” Using a pipeline approach was recommended to provide information and begin recruitment in undergraduate programs.

Most participants expressed beliefs that the PhD role is vital to the profession and should be prioritized, as the following quote characterizes: “This is the way to impact the future of the discipline. It is worth the investment and the effort!” Promoting the practical importance of research, the intrinsic vitality of a research career, and the nurse scientist image were expressed as important recommendations to increase PhD role awareness among students, practicing nurses, and the public.

Discussion

This study explored demographic and programmatic factors that may influence the research being conducted by PhD-prepared nurses and their scholarly productivity. While the proportion of PhD-prepared nurses in the workforce has remained fairly stable from 2013 to 2020,¹⁴ the trend may not hold, considering declines in PhD enrollment reported.¹⁵

Our sample of PhD-prepared nurses, drawn from across the nation, is similar to the predominant demographic profile of nurses in the United States, White females older than 50 years.¹⁴ Participants in this study were in their early 40s at the time of PhD completion, which is consistent with Fang and Zhan's¹⁶ AACN database study of US PhD-prepared nurses, and slightly younger than the late 40s average age previously reported on a national survey.¹⁷ Additionally, the average length to PhD graduation for our sample was under 5 years, slightly less than the 5.7 years to graduation previously reported,¹⁶ which may reflect efforts to support the nursing PhD pipeline with direct BSN-to-PhD and accelerated programs.

On average, our participants had completed their PhD 11 years prior to taking part in the study, and currently hold academic positions, often fulfilling dual roles (ie, administrative and faculty, or researcher/clinician and faculty), which is consistent with other authors' findings.^17,18 The majority had received research funding, with those who attended a public university significantly more likely to have had funded research, which may be related to well-established research infrastructure in these institutions. However, contrary to the thought some express at conferences and reflected in the literature favoring PhD programs at public universities,¹⁹ PhD-prepared nurses in this study were not significantly more likely to have had their education funded, completed a post-doc, received external funding, or have a successful publication record based on having attended a public or private university.

The length of time since graduation was significantly associated with higher academic roles and number of publications; however, half of the sample had 10 or fewer publications, including some participants who had graduated 11 to 20 years prior. Administrative roles or having a heavy teaching load may have impacted the number of publications for participants with many years of experience. Nonetheless, participants with over 50 publications had all graduated at least 11 years prior, indicating that longevity as a PhD-prepared nurse was an important factor to consider and supports the need to streamline PhD education to promote earlier graduation and younger nurse scientists and academicians.²⁰ Knowledge generation and dissemination take time, so it is not surprising that the number of publications would increase with the number of years as a PhD-prepared nurse.

The majority of PhD-prepared nurses in this study had published their dissertation, with the most prevalent topic category (health disparities/social determinants of health/vulnerable populations) well aligned with federal funding.²¹ This represents important generation of new knowledge for the discipline—which is the hallmark of PhD education.¹⁷ The second most frequent topic of dissertation research was studies pertaining to nurses or nursing students. This type of research is important as we seek to address the current and predicted nursing shortage.^14,22 The nursing faculty shortage is also a serious concern²³ that may be addressed through research regarding nursing students' experiences and role preparation.²⁴

The third most common topics were categorized as psychosocial/behavioral, which is an important aspect of holistic care, the framework underpinning the philosophy of nursing.²⁵ Symptom management, the fourth category, has long been a priority for funding agencies such as the NINR and considered intrinsic to nursing; hence, this area of nursing research is well developed.²⁶ While the stated categories are congruent with past and present NINR and NLN research priorities, new areas of research have been identified and will need to be developed. Expanded categories of emphasis from the 2022-2026 NINR strategic plan include population and community health, and systems and models of care addressing identified gaps.¹⁰ Participants also expressed the need for new areas of inquiry to attract younger nurses to PhD programs while meeting some of the most pressing needs of society (eg, environmental concerns and climate changes affecting health), ideas consistent with current literature.²¹

The fifth category reflects the overwhelming chronic health conditions nurses encounter at the bedside. The leading causes of mortality in the United States consistently include chronic diseases,²⁷ making this an important area of nursing research.

Funding type was weakly associated with years since graduation. Intramural funding was most common in the early years after graduation, and external funding more likely 9 or more years after graduation. External funding requires time to build upon earlier studies. Indeed, the National Institutes of Health has noted the trend of increased age of first-awarded investigators and the shift toward mid-career investigators.^28,29

Factors that may have influenced research output were expressed by participants and reflect their experience. The need for student funding and student research experience with faculty mentors were the top themes noted in the recommendations provided, echoing recent literature.^30,31 Program recommendations included promoting PhD program entry with new pathways and accelerated, flexible programs to increase access and diversity, while placing an emphasis on research experience and effective mentorship for both students and faculty. These recommendations are consistent with PhD program experts.^15,17,32,33 The need for faculty mentoring cannot be overlooked, as it is tied to developing a research trajectory as well as promotion and tenure. Valuing research and recognizing PhD-prepared nurses' contributions with enhanced pay (or equivalent to clinical pay) was also advised, reflecting reports in the literature regarding dissatisfaction with research support.^21,32 Finally, participants recommended various means of increasing PhD role awareness among nurses, other disciplines, and the public. The need for clear recognition of the PhD-prepared nurse's role and versatility has also been called for in the literature.^33,34

Limitations

These results should be understood in light of certain strengths and limitations. This study explored individual and programmatic factors to better understand PhD-prepared nurses' scholarship outcomes, an area of research previously noted as lacking.¹⁷ Although care was taken to recruit nationally representative study participants, our sample size was small, limiting generalizability. The institution where a PhD was earned was classified as public or private without the Carnegie Classification, limiting comparison. We did not include questions pertaining to research methodology used for dissertation or subsequent studies; therefore, the most prevalent type of research conducted by PhD-prepared nurses was not ascertained. The online survey provided was brief enough to encourage response, and included open-ended questions that enhanced the depth of responses shared by participants.³⁵ The potential for self-reporting bias must be considered, as the topic dealt with performance to some extent, which may have predisposed participants to favorably describe accomplishments.

Further research is required to explore solutions to these ongoing and emerging issues. Raising awareness of existing research agendas and priorities is important for the future. If a central database existed, where all current topics of interest to these many groups were compiled and easily accessed, PhD students and developing nurse researchers would be informed as to the research areas with known knowledge gaps, helping to shape the research trajectories of early career nurse scientists.

Previous discussions regarding the future of nursing PhD programs have relied on representatives of only the 10 highest intensity research programs.^15,36 If we are to foster inclusiveness and equal opportunity, resources must be allocated to all PhD programs. Not all students can leave their lives and go to such a top research-intensive school. All PhD programs and faculty in various regions need to be available to diverse populations where they live. This is important if we are to make inroads in terms of diversity, because at the undergraduate level these (often first generation) college students will need to be exposed to PhD nursing and encouraged to strive higher, earlier.^37,38 Additionally, remote or virtual fellowship opportunities and peer networks have emerged as alternatives to traditional in-person postdoctoral fellowships, which have limited availability,^15,37 and consistent with our sample in which only 25% of participants had postdoctoral training.

As US nursing schools face a proverbial gray wave of faculty retirement,¹⁴ we need to be cognizant of the new technologies that are being employed in all of education, especially higher education. Curricula need revision to excite and keep the interest of future generations of students. Artificial intelligence, data science, omics, and big data may need to be added to core courses, or at the very least, included by enhancing curriculum via seminars and symposia.³⁹

Conclusions

Key findings include that dissertation topics were broad and aligned with research priorities, and represent important generation of new knowledge for the discipline. However, the need for new areas of inquiry was also identified. Most participants had received either intramural or external research funding. Elements influencing research productivity include funding, dual academic roles, and longevity as a PhD-prepared nurse. Additional considerations must be given to the expressed need for new PhD educational pathways and increased access, research experience and mentoring throughout the educational journey, and financial support. Understanding of our current state of nursing science stewardship and intentionally mapping out where we want to be in the future for research, academia, and clinical practice will enhance our ability to strategically plan PhD programs accordingly.