Nurse-scientists usually begin their education with a Bachelor of Science in Nursing (BSN) degree; most enter clinical practice at that point. The nursing profession traditionally has viewed clinical experience as a prerequisite to graduate education and new graduates were encouraged to practice clinically by faculty and peers between degrees rather than continuing straight on to obtain a PhD.45 This career path has resulted in the norm of nurses returning for a master’s degree in their mid-thirties to become an advanced practice nurse (e.g., nurse practitioner or clinical nurse specialist) or administrator, then returning to the work force for another decade, and finally returning to graduate school to obtain a PhD in their late thirties or even older.46 Nurse-scientists complete their doctoral degrees, on average, at the age of 47, which limits the number of years they have to build a scientific program and contribute to the scientific base of nursing practice.47
Nurses with advanced degrees such as nurse practitioners, nurse anesthetists, and nurse executives command significantly higher salaries than nurse-scientist faculty at research institutions. This is an important disincentive to return to school to obtain a PhD. Although academics in all disciplines are rarely compensated at the same level as their peers in practice or industry, the disparity for nurses is one of the largest. In fact, clinical nurses working in hospitals or ambulatory care, nurse practitioners, nurse anesthetists and others have average salaries that are 30 percent higher than those of assistant professors of nursing.48
Despite the barriers cited above, nurse-scientist training has been on the upswing:
Schools of nursing offer both full- and part-time doctoral programs in order to attract and accommodate the best talent. In Fall 2012, 45 percent of 5,110 individuals enrolled in research-focused doctoral programs were enrolled part-time.52 However, part-time programs take longer to complete, which contributes to the older age of research faculty.
Table 4.1. Enrollment Changes in Nursing Schools, 2011-2012
|Enrollment Changes in Same Schools Reporting in Both 2011 and 2012 by Type of Degree (From Tables 11&12, AACN, 2013)|
|DEGREE||NUMBER OF SCHOOLS||2011 STUDENTS||2012 STUDENTS||INCREASE/
The development of a professional doctorate may also affect the numbers of nurses pursuing a PhD. The Doctor of Nursing Practice (DNP) was introduced in 2004 by the American Association of Colleges of Nursing (AACN) with a recommendation by its members to adopt the DNP degree for all advanced practice nurses by 2015. In 2012, 217 schools reported offering the DNP degree.
At the NIH, the National Institute of Nursing Research (NINR) supports training of nurse-scientists through intramural opportunities such as the Graduate Partnership Program and through extramural opportunities that include both institutional and individual training awards. For the GPP program, 16 nursing PhD students have participated to date. From an extramural perspective, NINR supports the T32 institutional training grants; F31, F32, and F33 individual fellowship awards; and the K01, K23, K24, and K99/R00 awards for early career investigators. In the past NINR also supported the K08 mechanism.
In response to the need for new nurse researchers and faculty, NINR currently spends approximately 8 percent of its appropriated funds on the training of nurse-scientists. As a percent of budget, this is more than most NIH Institutes and Centers (ICs) spend on pre- and post-doctoral training.
45 Dracup, K, Greiner, D.S., Haas, S.A., Kidd, P., Liegler, R., MacIntryre, R., et al.(2009). Faculty shortages in baccalaureate and graduate nursing programs: Scope of the problem and strategies for expanding the supply. Retrieved from: http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm As cited in: IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press p.I-36-37
46 IOM, 2011.
47 Dracup, 2009.
48 IOM. 2011.
49 Fang, Li, Bednash, AACN, 2013.
52 Fang, Li, Bednash, AACN, 2013.
53 American Association of Colleges of Nursing (2010). The research-focused doctoral program in nursing pathways to excellence.
54 IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
55 Fang, D. Li, Y., Bednash, G.D. (2013). 2012-13 enrollment and graduations in baccalaureate and graduate programs in nursing. American Association of Colleges of Nursing.