The 2011 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommended that the population of nurses with doctoral degrees be doubled by 2020. To that end, programs leading to a research doctorate (PhD) and practice doctorate (Doctor of Nursing Practice [DNP]) have proliferated and expanded throughout the United States (American Association of Colleges of Nursing, 2015).
Smeltzer and colleagues (2015, 2016) previously reported findings of their national survey of doctoral nursing faculty to ascertain the impact of this effort on the doctoral faculty's scholarly productivity and work life. This study was undertaken to examine doctoral faculty members' responses to an open-ended item soliciting any additional information they would like to share after completion of the survey.
METHOD
Institutional review board approval was obtained for the conduct of the research. As reported previously, focus groups of PhD and DNP faculty provided the basis for construction of the 73-item survey (Smeltzer et al., 2014a); properties of the survey were described previously (Smeltzer et al., 2015, 2016). The final item of the survey was an open-ended question: "Is there anything else about this topic that you would like to share or add? All comments are welcome."
Two members of the research team independently performed conventional content analysis of the responses to this question (Hsieh & Shannon, 2005). This method entails identification of key words in the transcribed interviews, coding the key words, and organizing and grouping the codes into meaningful clusters. This type of design is appropriate for expanding understanding of an experience when existing theory about it is limited.
Data collection took place from November 2013 through January 2014. A total of 1,197 faculty members at 71 randomly selected schools of nursing distributed in the Northeastern, Southern, Midwestern, and Western regions of the United States received email invitations to participate; 554 complete surveys from participants who met eligibility criteria were returned. Participants were eligible if they were full-time faculty with at least two years of experience in doctoral education. All were doctorally prepared; 49.1 percent were tenured, 31.6 percent were on a tenure line, and 19.3 percent were on a nontenure or clinical track.
Of 548 respondents who identified the type of doctoral programs in which they taught, 147 (26.8 percent) taught PhD students, 210 (38.3 percent) taught DNP students, and 191 (34.8 percent) taught both PhD and DNP students. Most faculty spent a significant amount of time teaching in other programs, and about one third of the respondents were currently engaged in clinical practice. The sample has been fully described elsewhere (Smeltzer et al., 2015, 2016).
RESULTS
The open-ended item had responses from 187 subjects. The largest number (n = 50) indicated that they had nothing to add, commented about the survey and its importance, or critiqued survey items. Substantive responses were provided by 137 respondents. In the vast majority of cases, comments addressed the general topic of the demands of an excessive workload; more than one fourth of the 137 respondents who provided substantive comments identified workload as a concern.
Specific facets of the workload issue that were identified by multiple participants included, in descending order of frequency, the impact of senior faculty members' aging and retirement on doctoral faculty workloads, lack of workload credit for dissertation or capstone work and the invisible nature of doctoral teaching, issues associated with the tenure track, work-life balance, issues associated with having the time to do scholarship, the shortage of faculty in the academic unit, and the burden of administrative responsibilities. Additional issues that were identified by multiple participants included faculty versus industry compensation, institutional barriers to scholarship, and issues associated with research funding.
Some responses addressed more than one of these categories. As an example, one respondent wrote: "This is the job that 'ate my life.' It wrecked a relationship because I could not set decent boundaries. No one understands that this work NEVER GOES AWAY[horizontal ellipsis]. They load you up till you burn out teaching[horizontal ellipsis]never providing teachers with the equivalent of a break[horizontal ellipsis]. And no one seems to care how much you work or what the morale is[horizontal ellipsis]. I have never been in an environment that is SO UNHEALTHY! People around here look like the 'walking dead.'"
Other comments echoed these concerns. Some respondents, on the other hand, shared comments that were positive, for example, noting the gratification of seeing students' progress. But these comments also included observations about the challenges of their workload.
Responses from multiple participants that specifically were associated with teaching in DNP programs also related generally to workload concerns. Specific concerns included, in descending order of frequency, challenges associated with time to fulfill all responsibilities expected of DNP faculty, too many students for the faculty to manage, and the practice requirements for faculty maintaining advanced practice certification. Additional concerns identified by multiple participants included the inexperience of and lack of mentoring for DNP program faculty, concern about insufficient rigor of the program in which they taught, and the inadequate preparation of DNP students for doctoral level study. One representative comment was: "More and more DNP students entering programs with not enough doctoral prepared faculty. Our faculty are tired and work day and night to try to catch up. Not enough time to truly think or discuss scholarly topics with colleagues. Never a day off!" Several respondents noted that their unsustainable workload was driving their decisions to retire earlier than planned or to return to full-time clinical practice.
DISCUSSION
The findings of this analysis contributed to the interpretation of the quantitative survey results (Smeltzer et al., 2015, 2016). Respondents evaluated their work-life balance more positively than expected, though overall workload and time spent working with doctoral students were important in the appraisal of work-life balance (Smeltzer et al., 2015). Workload and expectations associated with teaching, administrative support, and research support were identified as critical factors associated with faculty productivity (Smeltzer et al., 2016).
Findings of the current study reflected the review of the literature (Smeltzer et al., 2014b) as well as results of the focus group study that provided the basis for survey development (Smeltzer et al., 2014a). A limitation of this research was the failure to achieve a sample reflecting the national distribution of PhD versus DNP programs. The sample was fairly homogeneous, reflecting the national profile of doctoral faculty in nursing who are overwhelmingly near retirement age, Caucasian, and female.
CONCLUSION
The increase in the number and size of doctoral nursing programs in response to the Institute of Medicine (2011) report comes at a cost. This study reports concerns expressed by current doctoral nursing faculty and is consistent with other related reports. Administrators of nursing programs, including those who are responsible for the administration of PhD and DNP programs, should consider and respond to the issues that have been identified by faculty. Their response should focus on ensuring recruitment and retention of a faculty willing and qualified to support these doctoral programs and to fulfill the mission of preparing sufficient numbers of nurses with doctoral degrees. Questions for future research include the extent to which faculties have increased in number to support increases in program enrollment and ways in which PhD as well as DNP education might be designed to be more efficient.
Faculty compensation has been identified as a recruitment and retention barrier in national studies. In this study, workload issues were more prominent. Therefore, workload needs to be central to strategic planning to ensure the sustainability of doctoral education in nursing.
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