Doctoral Education in Nursing Views and Career Pathways
Recent decades have been characterized by continuous, transformational changes on a global level, a phenomenon particularly evident in healthcare. The changes in the delivery of healthcare services have affected both the practice and the education of all health professionals, especially for nurses. The changing needs of contemporary society, and nursing’s response to these, have resulted in a rapid expansion of nursing education, particularly in the university setting, and a demand for a variety of advanced practice and leadership opportunities.
While doctoral preparation has typically been seen as the pathway for a career in academia, the needs and dynamics in society have challenged this tradition in ways that could not have been anticipated 30 years ago. More recently, doctoral education, in nursing as in all disciplines, has received close examination in terms of the pressing needs of society and the deficiencies in doctoral programs in meeting these needs.
The supply of and demand for doctorly prepared nurses varies considerably as do the pathways that nurses take for doctoral preparation. The challenges of stakeholder needs and global forces, which present challenges to both the discipline and educational institutions, will also be examined. Case studies of doctorally prepared nurses are described to profile the different pathways and career trajectories that might be found in various settings. Finally, an agenda for present and future needs is presented.
Doctoral Education: The Traditional View
Graduate education in all disciplines is undergoing rapid change as a reflection of changing social dynamics. In the USA, the original vision for graduate education was to train scholars for the transmission and creation of knowledge.
Most US universities based their approaches to graduate education on the German model of education, emphasizing the generation of new knowledge. In the latter part of the twentieth century, however, the broad goals of doctoral education began to change, expanding beyond the expectations for generation of scientific knowledge through research and scholarly activities, to meeting the needs of society through leadership roles in a variety of settings .
In nursing doctoral education, two prevailing models for curriculum have evolved. These have been described as the European model and the North American model (Ketefian and Redman, 2001). Both of these models focus on advanced preparation in the discipline of nursing. In general, the purpose of these programs is to prepare scientists who are qualified to develop and test nursing knowledge and leaders who will assume positions in education or the healthcare delivery system.
In the European model, there generally is no or little formal coursework and the program is conducted through individually supervised research. In the North American model, there is extensive coursework, generally for one to two years, followed by comprehensive examinations and independent research culminating in the dissertation. Variations of these are now found in several areas of the world (Ketefian et al, 2001; McKenna and Cutcliffe, 2001).
Many disciplines, such as education, business and public health, have developed professional doctorates. Others, such as psychology, developed clinical doctorates. Nursing has followed this trend although there is no clear agreement as yet on the best approach. In Australia the professional nursing doctorate has adopted the North American PhD model.
In nursing, many programs in the USA do not differentiate much in program goals or curricula, even though the degrees that are conferred may vary. Nor is there evidence that prospective students make a deliberate choice for graduate study based on the type of degree offered (Redman and Ketefian , 1997). However, this broadening of the purposes of graduate study and the opportunities available for doctorally prepared graduates is evident in society today.
Internationally, nurses have responded to global changes in healthcare delivery in different ways. One response has been the further development of nurses’ educational preparation for practice and leadership. Williams (1996) described this need and urged African-American nurses to act on change through reeducation, in order to pioneer relevant and effective health outcomes for clients and their families.
At the present time the nursing profession, as do all health professions, demands evidence-based, outcome-driven care interventions, whatever the context of care. The discovery of new knowledge, rapidly changing social expectations and uncertainty within social structures, call for a critical review of nursing knowledge and skills. Continuing education, therefore, is an essential process at this time of national and global change ( Bazely , 2003).
Career Pathways for the Doctorly Prepared Nurse
While it is assumed that once a doctorate is obtained, the graduates will spend their career in academia , teaching and conducting research, which is not always the case. Some do not find an academy an attractive career pathway due to noncompetitive salaries, the general demands of a faculty position, and the struggles to maintain both family and a research career (Fogg, 2003). Limited data exists but what is available indicate a variety of career options that might be chosen (Committee on Dimensions, Causes and Implications of Recent Trends in the Careers of Life Scientists, 1998).
In all disciplines, employment in institutions of higher education was only slightly higher than 50%. This is somewhat misleading in the USA in that an additional 29% entered into postdoctoral fellowships which, for the most part, are carried out in university settings. What is surprising, however, is the fact that a number of graduates entered positions in industry or the political arena.
The comparable data for nursing doctoral graduates are also presented. While a larger number of nursing graduates become employed in educational institutions, the overall total is actually lower because far fewer nursing graduates enter into postdoctoral fellowships. Approximately 22% of nursing graduates in the USA and 49% in Australia assume non-academic positions in clinical research or practice, executive level administration, consultation and the policy arena.
Supply and Demand Issues
While large numbers of doctoral graduates do enter academic positions after graduation, the supply and demand issues vary across disciplines. For example, in the USA, there is a growing shortage of faculty in nursing programs and enrollments of qualified students are being affected because of this (Berlin and Sechrist, 2002; American Association of Colleges of Nursing [AACN], 2003).
This critical shortage of nursing faculty is due to a number of factors including aging of the current faculty with insufficient numbers of younger faculty to replace them, the unattractiveness of an academic career for new doctoral graduates and the lack of competitive salaries in academic settings when compared with the healthcare services sector or industry.
The US Bureau of Labor Statistics (cited in Phillips, 1998, p. 493) reveals that interest in research careers outside of the university system is appealing to many doctoral graduates, particularly in government departments and healthcare services as managers and administrators (Wolff, 1995 ; Taylor and Hardy, 1996); Industry and business are absorbing those with an interest outside of the traditional academic role, along with globalization of health goods, services and research, and the higher salaries offered outside of academia (Golde and Fiske, 2000; Smallwood, 2001).
For example, while the demand for postdoctoral science and psychology positions has traditionally been high, many doctoral students perceive that broadening their career horizons creates more employment opportunities and options, given the fluctuating funding of academic and university research positions over time (Zimpfer and DeTrude , 1990; Golde and Fiske, 2000).
The international nursing marketplace seeks nurses who can provide new types of services in ways not previously considered. Doctorly prepared nurses are creating opportunities to advance nursing scholarship, research and leadership, and are also contributing significantly to crafting social policy and setting the healthcare agenda (Horn, 1999). Exciting entrepreneurial opportunities presented themselves in the 1990s in the form of private healthcare agencies and consultancy services (Williams, 1996).
This shows that employers from a wide range of areas are interested in hiring PhDs (Horn, 1999), although the increasing number of doctoral graduates worldwide has attracted some criticism (see for example, Atwell, 1996). Given the relatively fewer numbers of nurses graduating with either PhDs or professional doctorates, their potential career horizon is limitless. These career opportunities may or may not have been considered by students during the doctoral journey itself.
Like most other health science students wishing to undertake higher degrees in their field, nurses have traditionally considered the doctorate as training for careers in academic and research fields (La Pidus , 1995; Magner, 1998; Horn, 1999; Moyer and Salovey, 1999) . The role of training through research is crucial in gaining this career path for doctoral graduates. Indeed, many disciplines describe doctoral training as a process of co-optation by peers (Deneef, 2000; Mangematin et al, 2000).
While the current figures on the percentages of graduating Australian nurses opting for academic careers are limited to responses on the Australian Universities Graduate Survey, approximately half choose academic careers. In countries where nursing education has been transferred to the tertiary education system over the past few decades, this trend is common (see, for example, Smith et al, 2000).
However, in countries like the USA, with a longer tradition of higher education in nursing, the career options for the doctoral graduate are broad, in line with career expectations (Moyer and Salovey, 1999). So far as research careers are concerned in the USA and UK, the US National Academy of Sciences (NAS) and the UK National Science Foundation (NSF) claim that only one third of those receiving doctorates expect to enter the academic tenure system (Phillips, 1998 ).
While fluctuations in market demand and supply have occurred for doctoral graduates in many disciplines since the early 1980s, this is not generally the case for nursing (Williams, 1996). However, given the increasing influence of world events on national job markets, all graduates are urged to maintain a degree of flexibility when searching for employment and making career choices (Deneef, 2000; McGinn, 2000; Smallwood, 2001).
Mangematin et al (2000) point out that a doctoral degree, unlike a coursework master’s degree, must comprise an essential component of a career plan, rather than be regarded as an automatic stepping-stone for gaining employment. For example, the academic market for health-related doctorates between 1986 and 1992 was far less than that for engineering, science and political science graduates, even though the number of graduates was small (Cheng and Davidson, 2001).
This is explained by the ‘cobweb model’ of supply and demand, where by the escalation of high market demand and wage prospects for doctoral graduates during the years they are studying begin to wane when the market becomes saturated with new graduates. These periods of ‘boom and bust’ are related to the lag time in the education process, a situation relevant to any doctoral graduate (Cheng and Davidson, 2001).
Another cause of disappointment for graduates in the job market is potential discrepancy between the employer’s expectations and the student’s educational training. If an employer is not looking primarily for a researcher skilled in a particular methodology with deep knowledge of a particular field of inquiry, but rather a skilled problem solver, team leader and catalyst for change, the doctoral graduate may need further experiential learning to meet the job requirements (Mangematin et al, 2000).
This has traditionally been the case for graduates of counseling (Zimpfer and DeTrude , 1990), chemistry (Brennan, 1997), political science and politics (Yin, 1998), and in the life sciences, behavioral and social sciences and in education (Malveaux , 1995).
In more recent years career options of female graduates have been hampered by employer expectations combined with the pressure of family commitments, such as an expectation that private time be employed to publish, family-unfriendly workplaces and tokenistic equal employment opportunities (Moyer and Salovey, 1999 ). While many doctoral graduates seek employment in prestigious university posts, these are often limited to those achieving high degrees and/or those who have maintained part-time employment within the academic department or faculty during their candidature (Xiao, 2000).
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