FEATURES

Dealing with reality: Confronting the global nursing shortage

On the cusp of change: What does a nurse with a practice doctorate look like?

by Kimberly Adams Tufts and Elizabeth R. Click

Kimberly Adams Tufts	Elizabeth Click

A database search of PubMed-indexed articles for the term “practice doctorate” yields numerous citations from recent years that relate to the Doctor of Nursing Practice (DNP) degree. [See www.pubmed.gov.] The current debate about the pros and cons of establishing educational programs that confer practice doctorates upon nurses—also referred to as clinical doctorates or professional doctorates—is not new (Christman, 1980; Fitzpatrick, 2003; Fulton & Lyon, 2005; Scholtfeldt, 1978).

The focus of the debate ranges widely and includes the following topics: 1) quality assurance issues related to curricular variations and requirements (Dracup, Cronenwett, Meleis, & Benner, 2005; O’Sullivan, Carter, Marion, Pohl, & Werner, 2005); 2) theoretical and metatheoretical implications of such preparation (Milton, 2005; Whall, 2005); 3) policy and planning issues, including resource allocation (Cartwright & Reed, 2005); 4) the impact of large numbers of DNP-prepared nurses on generation of new nursing knowledge and enrollment in PhD programs (Chase & Pruitt, 2006; Dracup et al.); and, 5) most importantly in our view, whether these programs adequately prepare nurses to function as quality faculty members (Tanner, 2005).

According to a 2005 white paper published by the American Association of Colleges of Nursing (AACN), the shortage of nurse educators is a looming crisis. In another document, the AACN (2003) reported that U.S. nursing schools turned away 15,944 qualified applicants to entry-level baccalaureate nursing programs in 2003 due to multiple factors, including insufficient number of faculty.

According to a 2002 document published by the National League for Nursing (NLN), as many as 40,000 full-time faculty members will be needed to teach the number of students required to provide nursing care for an increasingly diverse and aging population. Current workforce data suggest that fewer than 50 percent of the 40,000 nurse educators that will be needed are presently working in faculty roles (NLN). Yet, AACN (2005) recommendations for the practice doctorate focus on preparing nurses to assume roles in arenas other than education. The National League for Nursing asserts that the nurse educator role is a specialized one that requires careful, thoughtful and rigorous preparation, and that clinical advanced practice does not constitute adequate preparation for that position.

Must one hold a PhD to function as a quality faculty member? In light of its importance to the nursing profession and public health, we decided to explore the issue further. Are nurses who hold practice doctorates productive faculty members of schools of nursing? Historically, have these nurses assumed leadership roles as educators, clinicians and/or researchers?

Since the inception of the Doctor of Nursing (ND) program at Case Western Reserve University in 1979, several other institutions have introduced practice doctorate programs, producing graduates currently active in the profession. They include the University of Colorado at Denver and Health Sciences Center, Rush University, the University of South Carolina and the University of Tennessee Health Science Center. In the last four years, several other institutions have begun offering practice doctorates including Columbia University, Drexel University and the University of Kentucky. According to the AACN Web site (2007), nearly 140 other institutions are in the planning stages, and 19 have recently implemented degree programs that grant practice doctorates.

To gain better understanding of how well nurses who hold practice doctorates contribute to the educational process, we interviewed 18 people who have completed the degree program.

Valued and productive
Through networking, we identified nurses who might be willing to be interviewed and, in August 2004, began conducting phone interviews. Of the 23 nurses contacted via e-mail or telephone, five declined to speak with us. Over the next two years, we talked with 18 practice-doctorate nurses in four regions of the United States—two in the Northeast, 10 in the South, four in the Midwest and two in the West. Our discussions centered on a) the benefits of doctoral preparation, b) decisions regarding tenure-track positions, c) the scope of their professional roles and d) challenges encountered in academic environments. Ninety-five percent of the interviewees function in full-time faculty roles. From our discussions, we compiled the following composite profile.

Fifty-eight percent are assistant professors, 29 percent associate professors and 12 percent full professors. Seventeen percent hold faculty administrative positions. While the majority of these people have held full-time faculty positions for five or more years, the length of time in those positions ranges from two months to 17 years. In other words, the nurses we spoke with had diverse experience as faculty members. In the two years that we conducted these interviews, two of the nurses were promoted from assistant professor to associate professor and were granted tenure. Thus, five of the 18 are now tenured, and six are in tenure-track positions.
 
Eighty-nine percent of those interviewed are certified as advanced practice nurses. Sixty-seven percent have received funding for research from external sources. Of these, 33 percent received funding from the U.S. government’s Health Resources and Services Administration (HRSA), 28 percent from National Institutes of Health (NIH), and 61 percent from other sources, including the Centers for Disease Control and Prevention and the U.S. Department of Justice. That these nurses are valued and productive faculty members is evident, based on the numerous manuscripts they have published (392), funded projects in which they have participated (110), honors and awards they have received (108) and presentations they have given (498).

Clinicians, researchers and educators
Although continued discussion and research are needed to construct a more complete picture, the profile we’ve compiled supports our contention that nurses who hold practice doctorates are prepared to fully contribute to the nursing profession as clinicians, researchers and, most notably, educators. The contributions of the people we interviewed foreshadow the great promise that nurses earning practice doctorates hold for the future of nursing.

The movement toward establishment of practice doctorate programs as an educational standard presents a golden opportunity for producing adequate numbers of nurses prepared to assume the role of educator. If the nursing profession seizes this opportunity to prepare nurse educators who have extensive clinical experience, it will contribute not only to the educational missions of academic institutions, but also to the advancement of quality health care for the world’s people. RNL

Kimberly Adams Tufts, ND, APRN, FAAN, is associate professor in the School of Nursing, College of Health Sciences, at Old Dominion University in Norfolk, Virginia, USA. Elizabeth R. Click, RN, ND, CLE, is assistant professor in Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, USA.

References:
American Association of Colleges of Nursing. (2003). 2003-2004 enrollment and graduations in baccalaureate and graduate programs in nursing. Retrieved November 15, 2004, from http://www.aacn.nche.edu/Media/Backgrounders/
facultyshortage.htm

American Association of Colleges of Nursing. (2005). Faculty shortages in baccalaureate and graduate nursing programs: Scope of the problem and strategies for expanding the supply. Retrieved October 16, 2007, from http://www.aacn.nche.edu/Publications/WhitePapers/
FacultyShortages.htm

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved December 31, 2006, from http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf

American Association of Colleges of Nursing. (2007). Doctor of nursing practice (DNP) programs. Retrieved March 7, 2007, from http://www.aacn.nche.edu/DNP/DNPProgramList.htm

Cartwright, C., & Reed, C. (2005). Policy and planning perspectives for the doctorate in nursing practice. Online Journal of Issues in Nursing, 10(3), Manuscript 6. Retrieved October, 14, 2005, from http://www.nursingworld.org/ojin/topic28/tpc28_6.htm

Chase, S.K., & Pruitt, R.H. (2006). The practice doctorate: Innovation or disruption? Journal of Nursing Education, 45(5), 155-161.

Christman, L. (1980). Leadership in practice. Image: Journal of Nursing Scholarship, 12, 31-33.

Dracup, K., Cronenwett, L., Meleis, A.L., & Benner, P.E. (2005). Reflections on the doctorate of nursing practice. Nursing Outlook, 53(4), 177-182.

Fitzpatrick, J.J. (2003). The case for the clinical doctorate in nursing. Reflections on Nursing Leadership, 29(1), 8-9, 37.

Fulton, J., & Lyon, B. (2005). The need for some sense making: Doctor of nursing practice. Online Journal of Issues in Nursing, 10(3), Manuscript 3. Retrieved October 14, 2005, from http://www.nursingworld.org/ojin/topic28/tpc28_3.htm

Milton, C.L. (2005). Scholarship in nursing: Ethics of a practice doctorate. Nursing Science Quarterly, 18(2), 113-116.

National League for Nursing. (2002). Faculty shortages in baccalaureate and graduate nursing programs: Scope of the problem and strategies for expanding the supply. Retrieved November 15, 2004, from http://www.nln.org/aboutnln/PositionStatements/index.htm

O’Sullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together: The practice doctorate in nursing. Online Journal of Issues in Nursing, 10(3), Manuscript 4. Retrieved October 14, 2005, from http://www.nursingworld.org/ojin/topic28/tpc28_4.htm

Scholtfeldt, R.M. (1978). The professional doctorate: Rationale and characteristics. Nursing Outlook, 26(5), 302-311.

Tanner, C. (2005). What are our priorities? Addressing the looming shortage of nursing faculty. The Journal of Nursing Education, 44(6), 247-248.

Whall. A.L. (2005). “Lest we forget”: An issue concerning the doctorate in nursing practice. Nursing Outlook, 53(1), 1.