Doctor of Nursing Practice (DNP), Doctoral Education, Nursing Education, Nursing Education Research



  1. Robinson, Lisa Bridwell
  2. Volkert, Delene


Abstract: The purpose of this study was to explore, analyze, and describe nursing doctoral students' perceptions of factors that impacted them during their doctoral program. Answers to an open-ended question, in a national descriptive survey study of nursing doctoral students across the United States, were analyzed using Colaizzi procedural methods as a guideline. The content analysis identified issues unique to doctor of nursing practice (DNP) students that related to lack of clarity for the DNP degree and student concerns within academic settings. Recommendations include having DNP faculty on DNP project committees and standardization of guidelines to ensure rigor and consistency.


Article Content

The shortage of nurse educators continues to rise as nursing programs expand and current faculty retire. Latest estimates by the National League for Nursing (NLN, 2017) indicate that 34,200 new nurse faculty will be needed by 2022. For colleges of nursing situated in a university system, there is the added burden to enhance their staff by increasing the number of doctorally prepared faculty (NLN, 2017). An American Association of Colleges of Nursing (AACN, 2017) report on faculty vacancies showed that more than 56 percent of colleges reported having full-time faculty positions unfilled. Of the schools reporting faculty vacancies, 93 percent of those positions either required or preferred a doctoral degree. A limited pool of doctorally prepared faculty was reported as the greatest issue related to faculty recruitment (AACN, 2017). However, Cohen (2011) stated attrition in doctoral programs in the United States is 50 percent or higher. Few studies have addressed how stress and social support affect nursing doctoral students' intent to leave their programs of study (Cathro, 2011; Cohen, 2011).


Volkert, Candela, and Bernacki (2018) found that support issues and program stressors were significant predictors for nursing doctoral students to leave their current programs of study. Deci and Ryan's (2012) self-determination theory was the guiding framework for the study, as motivation is vital to persistence, yet can be influenced by external factors, including support systems. The purpose of the study was to identify predictors of nursing doctoral students' program completion in relation to social support. Sun et al. (2016) defined social support as a person's perceptions of general support or supportable behavior. Perceived stress can be mitigated by the perception of social support (Sun et al., 2016).



Institutional review board approval for the descriptive survey research study was obtained from the University of West Georgia. In spring 2017, a Qualtrics survey link with a description of the research and instructions was emailed to 339 deans/directors of all accredited nursing schools in the United States that conferred PhD, nursing EdD, and doctor of nursing practice (DNP) degrees. The email requested deans/directors to forward the link and study information to graduate nursing students in their institution. Links to the survey were confidential, and accessing the link implied consent.


The survey consisted of the following demographic information: gender, ethnicity, age, number of hours working, years of nursing experience, relationship status, caregiver responsibilities, number of individuals in the home, program of study, years in the program, and phase of the program. Four questions related to the student's intent to leave the program of study. Questions were scored on a 6-point Likert scale, with scores ranging from 1 (strongly disagree) to 6 (strongly agree).


Two tools were used for the study. The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) contains 12 items that measure perceived social support from family, friends, and significant other. It uses a 7-point Likert scale with scores ranging from strongly to strongly agree; higher scores indicate greater perceived social support (Zimet et al., 1988). The MSPSS has shown good internal consistency and discriminant validity (Mahmoud, Staten, Lennie, & Hall, 2015). The second tool, Cohen's Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983), is a 14-item scale that uses a 5-point Likert scale with scores ranging from 0 (never) to 4 (very often). The PSS is designed to measure the degree life situations are appraised as stressful (Cohen et al., 1983). Cronbach's reliability of the MSPSS scales were family ([alpha] = .93), friends ([alpha] = .95), and significant other ([alpha] = .95). The reliability of the PSS was [alpha] = .91.



The survey was opened by 486 individuals and completed by 442 for a completion rate of 91 percent. Ninety-one percent of participants were female; 82 percent were white; and 74 percent were either married or living with a significant other. On average, the participants were 42 years old (SD = 11.6) and reported 16.3 (SD = 12.3) years of experience. Participants were in PhD (22 percent), Nursing EdD (8 percent), or DNP (71 percent) programs. Fifty-eight percent of participants reported that they were in the coursework stage of their program; 42 percent were in the capstone/dissertation stage. An overwhelming majority (93 percent) had a job outside the program and worked an average of 37.3 (SD = 12.3) hours per week. Almost half had no caregiver responsibilities (48 percent); another third (31 percent) shared caregiving of their children; and the remaining participants were either caregivers for adults (14 percent) or had responsibilities for both children and adults (7 percent).


No differences were found in intent to leave, perceived stress, or types of social support (family, friends, or significant other) based on type of degree (PhD, DNP, EdD) program (F = 1.66, p = .09), stage (coursework or capstone/dissertation) of program (F = 2.05, p = .07), or job (yes/no) outside the program (F = 1.36, p = .24). Participants who were in the coursework phase of the program reported higher intent to leave than those who had reached the dissertation or capstone phase (F = 5.16, p = .02). A multiple regression found three significant predictors (higher overall stress, less support from friends, and more hours working at a job) that predicted 13 percent of the variance in intent to leave a doctoral program.



It is important to note that the inability to accurately determine response rate due to the recruitment methodology is a study limitation. In addition, the three identified predictors only account for 13 percent of the identified variance for intent to leave, indicating there are additional factors that need exploration with future research. Important issues for future studies may be the impact of factors within the university setting; these could include university policies and procedures that impact students and the relationships and support that students develop with faculty, advisors, and peers.



The study by Volkert et al. (2018) focused on the issues of program stressors and support as predictors of intent to leave doctoral study. However, the findings of this study identified that nurses working more hours at a job were likely to leave their program of study. Investigation into methods to provide increased support to those nurses in the highest stressed groups is needed.


Nursing doctoral students are most likely to leave their programs of study during the coursework phase of their program, which may suggest universities should seek ways to provide supplemental funding, allowing students to work less, especially in the beginning of their program of study. Balancing financial concerns is a consistent stress reported by students (Cohen, 2011; Sarver, Cichra, & Kline, 2015). Public and private funding opportunities, scholarships, and graduate assistantships all could potentially benefit students, thereby decreasing some of the perceived stress of doctoral studies.


With the understanding that many doctoral nursing students already serve as nursing faculty members, allowing these students a lighter teaching load, course release, or educational sabbaticals could also be a creative way to alleviate some of the stresses associated with nursing doctoral program coursework. This supports the finding that management of multiple role responsibilities results in feelings of being overwhelmed (Cohen, 2011). Even though the model of graduate education is shifting from the traditional university campus to the online learning environment, the demands of nursing doctoral programs are just as rigorous and require extensive effort and time. The continued shortage of doctorally prepared nursing faculty mandates the implementation of new strategies to support nursing doctoral students.




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