Nurses prepared at different levels of education make meaningful contributions to the discipline of nursing, whether at the bedside, in lecture halls where future nurses are educated, or through research that advances the science of nursing. All of these are necessary. According to American Association of Colleges of Nursing (AACN) data, only 1% of nurses hold a doctoral degree. Owing to this severe shortage of doctorally prepared nurses, research contributions that could advance practice are not being made and the education of new nurses is being undermined. One measure that could mitigate this shortage is a wider embrace of a seamless model of nursing education, in which students enter graduate programs immediately after completing undergraduate studies.
I was first informed of the option to pursue my PhD immediately after completing my bachelor's degree by one of my undergraduate professors. Some nurse colleagues and professors expressed skepticism about my choice to begin graduate studies right away. A number urged me to do two to five years of clinical work first.
The culture of the nursing profession has long encouraged or even required a period of full-time work before applying to graduate programs. I'm not aware of any evidence that supports the need for doctoral students to first obtain several years of clinical experience. I've found that students can be successful in graduate programs and as academic nurses even without mastering direct care techniques; the duration of bedside practice does not determine the success of a graduate student. The students in my PhD cohort with limited bedside knowledge are able to contribute to class discussions (even when the core of these conversations is clinical), complete course work thoughtfully, and develop research programs that aim to solve pertinent issues within the discipline. It is also possible for seamless learners to gain clinical experience by working part time to minimize problems that might occur because of limited bedside experience.
A crucial advantage of seamless academic progression is that nurses will earn PhDs at a younger age. The AACN has reported that almost half of nurses obtaining PhDs in 2002 were between the ages of 45 and 54, and the median retirement age was 63, allowing very few years for these nurses to function as educators and researchers before retiring. This situation has not improved in recent years. When a large percentage of nurses obtain advanced degrees so close to retirement, their potential for long-term research contributions and work as faculty members is limited. Nursing schools currently report an overall faculty vacancy rate of over 8%, with some having as many as 15 vacant positions. The AACN reported that in 2011, owing to faculty vacancies and other constraints, over 75,000 qualified nursing school applicants were denied entrance to baccalaureate and graduate nursing programs. The number of nursing faculty vacancies is likely to grow, as several hundred nursing faculty are expected to retire annually over the next 10 years.
Nurses who pursue PhDs earlier in their careers have the potential to contribute to teaching and research for a number of decades before retirement. The extra years will be invaluable in the advancement of the discipline through sustained research, generating new evidence, and closing knowledge gaps in areas such as policy and patient care.
Do we still need a change of culture regarding the importance of clinical experience before entering graduate studies in nursing? Yes. Nurse faculty should inform undergraduates of the seamless option early on in nursing school. Nursing organizations should establish or contribute to scholarship programs for nurses pursuing the seamless route. And clinical nurses should not continue to encourage nursing students to practice for an arbitrary number of years before pursuing an advanced degree. The discipline of nursing stands to gain greatly if the number of doctorally prepared researchers, educators, and leaders grows and the length of an academic nurse's career increases.