"We're at a watershed": The positioning of PhD nurses in clinical practice

PhD-DNP Collaboration: An Integrative Review of Scholarly Partnerships in Nursing

Nurses holding terminal degrees, Doctor of Philosophy (PhD), Doctor of Nursing Science (DNS), and Doctor of Nursing Practice (DNP), fulfill different roles in nursing. The continued growth of nursing science and practice is dependent on alliances between these nurses that produce state-of-the-art knowledge and support the translation of evidence to practice. This integrative review described characteristics of scholarly collaborations between nurses holding a research-focused degree, the PhD, and those holding a practice-focused degree, the DNP. Five major nursing, medicine, and education databases were searched for peer-reviewed, original articles addressing or describing the characteristics of PhD-DNP scholarly collaborations, published through March 2023. In total, 15 articles met the inclusion criteria, and an integrative synthesis was conducted using constant comparison and thematic analysis. Findings included one overarching theme, Role Clarification, as well as four subthemes that emerged across the sample, describing key characteristics of collaborative PhD-DNP scholarship: (1) Mutual understanding and appreciation of strengths; (2) Strategic project planning and team building; (3) Clear organizational/administrative directives and guidance; and (4) Shared goals for the nursing profession. Articles describing the collaboration between nurses holding doctoral degrees are limited and provide primarily lower-level research evidence and evidence-based practice outcomes. Despite efforts to foster scholarly collaborations among nurses holding terminal degrees, more research is needed to clarify individual roles, offer tangible strategies for collaboration, and measure outcomes of collaboration benefitting healthcare systems, patient outcomes, and the nursing profession. This integrative review involved only the review of the extant literature.

Being a nurse between research and clinic: What challenges and opportunities for a PhD-prepared nurse? Overview from an Italian paediatric hospital

AIM

To report a reflection on the role, challenges and opportunities for nurses with advanced education in research outside the academic field.

DESIGN

A discursive paper.

DATA SOURCES

We reported the case of an Italian paediatric research hospital where PhD-prepared nurses started to apply their knowledge and competencies in different fields, both in clinical and organizational settings. From this experience, an overview of the possible barriers and challenges that PhD-prepared nurses may face up within the hospital setting.

DISCUSSION

The application of PhD-prepared nurses in hospital settings could be an opportunity to advance high standards of quality of care in managerial and clinical areas and to create networks between highly specialized professional figures and different clinical-care realities.

CONCLUSION

More research is needed to explore how to apply the advanced competencies of PhD-prepared nurses within healthcare organizations to provide high-quality and safe care and services. This paper can provide insights for a reflection on applying and developing PhD-prepared nurses' skills and competencies within the hospital setting in clinical, research and managerial areas. This can enhance the effective application of highly competent nursing professional figures.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution, due to study design.

Developing a clinical academic career pathway in a Community and Mental Health NHS Trust

Background

Despite growing evidence of the impact that clinical academic (CA) staff have on patient care and clinical practice, there are disproportionately low numbers of nurses, allied health professionals (AHPs) and other healthcare professionals in CA joint roles, compared to their medical colleagues.

Aim

To describe the initial development of a CA career pathway for nurses, AHPs and other healthcare professionals in a Community and Mental Health NHS Trust.

Methods

Kotter's 8-Step Change Model was used to expand opportunities and research culture across an NHS Trust.

Results

A variety of capacity and capability initiatives at different academic levels were created to support CA development and to complement those available externally. These opportunities were underpinned by a research and development strategy, senior leadership buy-in, manager and clinical staff support, and targeted organisation-wide communication.

Conclusion

The ongoing development of innovative CA opportunities in the Trust, alongside greater support for staff interested in pursuing CA careers, has resulted in a growing number of individuals successful in developing as CAs. This has led to a growth in research culture in the organisation and a greater understanding of what CA staff can bring to patient care, the clinical service and the wider organisation.

Clinical practice experience of doctor of philosophy nurses in South Korea: a qualitative study

Purpose

This study aimed to gain a broader understanding of the clinical practice experience of Doctor of Philosophy nurses working in nursing positions.

Method

Participants were 15 full-time nurses who are current Doctor of Philosophy candidates or have acquired a Doctor of Philosophy in nursing. Data were collected through face-to-face interviews and the participants’ diaries, which were analysed using a descriptive qualitative method.

Results

The patient care experiences of Doctor of Philosophy nurses in clinical practice were grouped into four themes: “providing evidence-based and patient-specific education,” “proactively taking responsible for communicating with patients,” “enhancing the quality of nursing through reflective attitudes,” and “advocating for patients using a multifaceted approach.” The factors facilitating or inhibiting clinical practice were identified with three themes.

Conclusion

This study revealed that the Doctor of Philosophy nurses used the knowledge and experience they gained in their Doctor of Philosophy nursing programme to serve as role models for the advancement of nursing education and evidence-based practice.

Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment

Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described-either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.

Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study

AIMS AND OBJECTIVES

To explore leadership experiences and the influence of leadership on career development of PhD-prepared nurses working in hospitals.

BACKGROUND

The Doctor of Philosophy (PhD) represents the highest level of education for a career in research and scholarship. PhD-prepared nurses have an important role in advancing the nursing discipline by conducting and implementing research finding. Given the rapidly changing health care environment, there is a clear need for PhD-prepared nurses with strong leadership competences. Currently, there is a dearth of studies exploring leadership of PhD-prepared nurses working in hospitals.

DESIGN

A descriptive qualitative study.

METHOD

A purposive sample with PhD-prepared nurses employed at clinical departments was used. Twelve interviews were conducted with participants from seven hospitals. Perceptions towards leadership, leadership experiences, leadership barriers and the influence of leadership on career development were discussed. Interviews were thematically analysed. Reporting followed the COREQ guidelines.

RESULTS

Three themes addressing leadership experiences were found: (1) "Leadership is needed for career development" describes how participants took initiative and received support from colleagues and mentors; (2) "Practicing leadership behaviours" describes leadership behaviours and feelings associated with leadership and (3) "Leadership influenced by the hospital setting" describes the working environment including struggling nursing research cultures and infrastructures with limited positions, managerial support and opportunities for collaboration.

CONCLUSION

Although participants showed leadership to advance their careers, barriers related to working environment were found. Stakeholders should invest into opportunities to develop and utilise leadership competences and development of strong nursing research cultures and infrastructures with sustainable career frameworks and positions.

RELEVANCE FOR CLINICAL PRACTICE

There is a need for ongoing efforts to build strong leadership competences as well as nursing research cultures and infrastructures with career pathways and suitable positions for PhD-prepared nurses within hospitals to empower them to strengthen nursing.

Three-Year Nursing PhD Model Recommendations from the RWJF Future of Nursing Scholars

BACKGROUND

In response to the 2011 Future of Nursing report, the Robert Wood Johnson Foundation created the Future of Nursing Scholars (FNS) Program in partnership with select schools of nursing to increase the number of PhD-prepared nurses using a 3-year curriculum.

METHOD

A group of scholars and FNS administrative leaders reflect on lessons learned for stakeholders planning to pursue a 3-year PhD model using personal experiences and extant literature.

RESULTS

Several factors should be considered prior to engaging in a 3-year PhD timeline, including mentorship, data collection approaches, methodological choices, and the need to balance multiple personal and professional loyalties. Considerations, strategies, and recommendations are provided for schools of nursing, faculty, mentors, and students.

CONCLUSION

The recommendations provided add to a growing body of knowledge that will create a foundation for understanding what factors constitute "success" for both PhD programs and students. [J Nurs Educ. 2022;61(1):19-28.].

Doctoral programmes in the nursing discipline: a scoping review

Background

This study aimed to map and summarise the state of the research regarding doctoral programs in nursing, as well as the issues debated in the context of nursing doctoral education. A Scoping Review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension scoping reviews statement (PRISMA-ScR) was conducted. Three electronic bibliographic data bases were searched: Cumulative Index to Nursing and Allied Health Literature Complete, Medline (on EBSCO Host) and SCOPUS to identify empirical studies published between January 2009 and December 2019. The review process was based on framework identified by Arksey and O’Malley and further revised by Levac and colleagues. Analysis was performed with the use of the Donabedian framework regarding the structure of the doctorate programmes, the process, and the outcomes.

Results

The review included 41 articles, mostly originating in the United States (n=26) and Europe (n=8), mainly by collecting the perceptions of students and faculty members with descriptive studies. The following issues were investigated at the (a) structure level: Prerequisite for doctoral candidates, Qualifications of faculty members, Mission of doctoral programs; (b) process level: Doctoral programs contents, Doctoral programs resources and quality, Mentoring and supervision, Doing doctorate abroad; and (c) outcome level: Academic performance outcomes in doctoral programs, Doctoral graduates’ competences, Doctoral students/graduates’ satisfaction, Doctoral graduates’ challenges.

Conclusions

Doctoral programs have mainly been investigated to date with descriptive studies, suggesting more robust research investigating the effectiveness of strategies to prepare future scientists in the nursing discipline. Doctorates are different across countries, and there is no visible cooperation of scholars internationally; their structure and processes have been reported to be stable over the years, thus not following the research development in nursing, discipline and practice expectations. Moreover, no clear framework of outcomes in the short- and long-term have been established to date to measure the quality and effectiveness of doctorate education. National and global strategies might establish common structure, process and outcome frameworks, as well as promote robust studies that are capable of assessing the effectiveness of this field of education.

Neonatal nursing led research activity in the UK: a survey of current practice

Background

Neonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK.

Methods

The study used a web-based survey design and neonatal nurses were eligible if they were working at or towards Masters or Doctoral level qualification in the UK. The survey was distributed to members of the Neonatal Nurses Association, UK Schools of Nursing and shared on social media pages of authors and professional organisations. Results were analysed using descriptive and frequency statistics and content analysis.

Results

Of the 56 respondents, 14% (n = 8) had a Doctoral level qualification and 43% (n = 24) of participants held a Masters qualification. Lack of time and funding knowledge was the largest barrier to research. Only 30% (n = 3) of participants had a research mentor and only 18% (n = 3) were from a neonatal nursing background.

Conclusions

There are limited numbers of neonatal nurses undertaking or leading nursing research in the UK. Further support is required to enhance clinical academic career trajectories to ensure research is a viable pathway for future generations of neonatal nurses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00719-8.

A comparative study of PhD and DNP nurses in an integrated health care system

BACKGROUND

A vast literature exists on doctorally-prepared RNs in academia, but little is known about those in practice settings.

PURPOSE

The purpose of this study was to explore demographic, educational, and employment characteristics, as well as practice patterns and professional accomplishments of doctorally-prepared RNs in one practice setting.

METHODS

Survey of approximately 100 doctorally-prepared RNs in an integrated health system were surveyed.

DISCUSSION

Doctors of Nursing Practice (DNPs) outnumber PhDs three to one in the institution. Several statistically significant differences exist between them: DNPs are younger and most likely hold advanced practice nursing positions; PhDs are 10 years older and more likely hold administrative or leadership positions. Little evidence exists that neither nurses nor administrators understand the skills and knowledge that doctorally-prepared RNs bring to the organization. This is particularly true for DNPs who predominantly hold clinical positions also held by master's-prepared RNs.

CONCLUSION

Advocates for continued growth of DNPs in academia and practice should partner more closely to clarify the skills and talents that doctorally-prepared nurses bring to clinical settings.

The role of doctoral-educated nurses in the clinical setting: Findings from a scoping review

AIMS AND OBJECTIVES

To map and summarise published studies on the career opportunities and roles of doctoral-educated (PhD and DNP) nurses in the clinical setting; to collate actions as proposed in the literature to promote career opportunities and roles for PhD and DNP nurses in the clinical setting.

BACKGROUND

To improve healthcare outcomes and strengthen leadership in nursing practice, there is the need to place nurses with a doctorate in clinical settings. However, available evidence has never been summarised to map the state of the science in this field.

DESIGN

A scoping review, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews statement (PRISMA-ScR).

METHODS

An electronic database of literature was searched by accessing CINAHL Complete and Medline (on EBSCO Host) and SCOPUS to identify studies published between January 2009-December 2019. A thematic analysis was performed by identifying emerging patterns in the research questions.

RESULTS

Ten studies were found with three types of clinical engagement: (a) a practice influencer/developer; (b) a clinical leader; and (c) a clinical teacher for students. Working in clinical areas, doctoral-educated nurses might influence several outcomes at the patient, research, staff and organisational levels.

CONCLUSIONS

Clinical roles for doctoral-educated nurses are still uncommon. However, in the last ten years, a debate has started to identify the possible careers in clinical settings, the needs and the challenges encountered while developing clinical academic roles, as well as the outcomes and actions that should be undertaken.

RELEVANCE TO CLINICAL PRACTICE

Academic nursing bodies, working with professional bodies and healthcare institutions at different levels, are called on to develop career frameworks, allowing the opportunity for doctoral-educated nurses to be involved in clinical practice and to influence its quality and performance; this might in turn lead to an increase in the quality of research.

A survey of nurses' experience integrating oncology clinical and academic worlds

Aim

To better understand how oncology nurses (a) navigate graduate studies; (b) perceive the impact of their academic work on their clinical practice, and vice versa; and (c) engage with clinical settings following graduate work.

Design

Interpretive descriptive cross‐sectional survey.

Methods

A qualitative exploratory web‐based survey exploring integration of graduate studies and clinical nursing practice.

Results

About 87 participants from seven countries responded. 71% were employed in clinical settings, 53% were enrolled in/graduated from Master's programs; 47% were enrolled in/graduated from doctoral programs. Participants had diverse motivations for pursuing graduate studies and improving clinical care. Participants reported graduate preparation increased their ability to provide quality care and conduct research. Lack of time and institutional structures were challenges to integrating clinical work and academic pursuits.

Conclusions

Given the many constraints and numerous benefits of nurses engaging in graduate work, structures and strategies to support hybrid roles should be explored.

Roles and functions in clinical care for registered nurses with a PhD-A systematic literature review

BACKGROUND

Nurses are responsible for nursing care and their expertise is crucial for quality of care. One factor important to successful delivery of evidence-based care is availability of staff with the expertise to support their colleagues in this endeavour. RN/PhDs versed in scientific research with a thorough knowledge of their disciplines have the potential to help narrow the gap between theory and practice. The roles and functions of RN/PhDs involved in clinical care have not yet been well defined.

AIM

To explore publications concerning clinical contributions from registered nurses who hold a PhD (RN/PhDs) regarding impact on quality and improvement of care.

METHOD

A systematic literature review was conducted and qualitative content analysis was applied to the data obtained from the included studies.

FINDINGS

The leadership role is considered essential for RN/PhDs, where the focus is on the pursuit of evidence-based practice and the improvement of nursing practices. The opportunity to combine the clinical and academic aspects of nursing is considered crucial in order for RN/PhDs to influence and improve care, yet few such positions are currently available. RN/PhDs cited limited career opportunities as one important reason for not combining clinical and academic work.

CONCLUSIONS

In order for nursing practice to reach full potential, clinical positions with clearly defined job descriptions for RN/PhDs are needed. To fully leverage their expertise, it is important to allocate sufficient time to conduct relevant research, as well as to support colleagues and students in the improvement of clinical practice.

Exploring the role complexity and workforce needs of doctoral-prepared nurses

Veterans Health Administration (VHA) Office of Nursing Services (ONS) is committed to encouraging and sustaining a positive culture that values doctoral-prepared nurses. Responding to needs cited in open-ended responses from the first ever survey of VHA's doctoral-prepared nurse workforce will require: providing and encouraging formal advanced degree achievement recognition; further opportunities for professional development and potential promotion; and support for nurse research activities at the local and national level. ONS recognizes the need for further research and evaluation related to VHA doctoral-prepared nurses to better understand both the outcomes they drive and what drives them.

Embedding post-doctoral clinical academic careers in practice: The St Bartholomew's Hospital model

AIMS AND OBJECTIVES

In order to retain and develop pre-doctoral and doctoral staff, we sought to establish and implement a model for supporting postdoctoral clinical academic careers at our hospital.

BACKGROUND

Doctorally-prepared nurses can raise clinical practice standards, but there is a deficit of career opportunities and post-doctoral positions. This will inevitably impact delivering the evidence for improving patient outcomes and service delivery. It is therefore imperative that post-doctoral nursing and allied professional post-doctoral clinical academic career opportunities are developed and embedded in practice.

DESIGN

We describe the development and implementation of a model to provide and embed post-doctoral clinical academic roles at our hospital.

METHODS

A multidisciplinary group devised the model which was approved by the Hospital Executive Board.

RESULTS

The model includes having a bespoke plan for each individual, planning the post-doctoral role at time of PhD planning, providing 1 day a week protected research time for a minimum of 12 months after PhD completion, having an appropriate honorary academic contract at a partner University, and providing integrated clinical and academic supervision throughout. Other key components include senior clinical and Executive Board support and an existing vibrant research culture at our organisation.

CONCLUSIONS

The St Bartholomew's Hospital model, focusing on individualised posts integrating clinical and academic roles to address service needs, offers a novel approach to supporting post-doctoral clinical academic careers in a clinical setting.

RELEVANCE TO CLINICAL PRACTICE

Since doctorally-prepared nurses can raise clinical practice standards we developed a sustainable infrastructure to increase our postdoctoral nursing and allied professional workforce. This model could provide a framework for other hospitals to embed postdoctoral clinical academic careers in practice.