The Evolution of Doctoral Education in Nursing

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OBJECTIVES 1. Discuss the history of doctoral education in general and © Jonesnursing & Bartlett doctoral Learning, programs in LLC particular. © Jones & Bartlett Learning, LLC NOT 2.FOR Differentiate SALE OR between DISTRIBUTION the different titles and structures forNOT FOR SALE OR DISTRIBUTION doctoral degrees in nursing. 3. Discuss some of the controversies surrounding the pros and cons of doctoral degrees in nursing © Jones & Bartlett4. Learning, List different LLC approaches that will influence© Jones the future & Bartlett of Learning, LLC NOT FOR SALE OR DISTRIBUTIONnursing doctorates. NOT FOR SALE OR DISTRIBUTION

INTRODUCTION Ages, but it was during the 20th century One of the most important aspects of any that the United States saw a dramatic prolif- © Jones & Bartlett Learning,profession LLC is the appropriate educational© Joneseration & of Bartlett doctoral educational Learning, programs LLC in NOT FOR SALE OR DISTRIBUTIONpreparation of the leaders of the discipline.NOT almostFOR everySALE academic OR DISTRIBUTION field. The model of Almost without exception, the professions education that was created in the United require that their leaders must hold doc- States was built on earlier models from toral degrees. The broad purposes of doc- European universities. However, doctoral toral educational programs are to provide programs in the United States took on their preparation© Jones that leads& Bartlett to careers Learning, in govern- LLCown unique characteristics. © Jones & Bartlett Learning, LLC ment,NOT business, FOR and SALE industr ORy, asDISTRIBUTION well as Nursing doctoral programsNOT began FOR in SALE OR DISTRIBUTION academia (CAGS, 1990). Doctoral programs the later part of the 20th century, after have been in existence since the Middle their development in most other fields.

28 I Chapter 3 The Evolution of Doctoral Education in Nursing

Perhaps this© Jones delay was & becauseBartlett of Learning,nursing’s LLCcertainly not for the general masses.© Jones Given this& Bartlett Learning, LLC unique history among the professions. Nursing early tie with the Church, we can understand in the UnitedNOT States FOR began SALE outside OR the DISTRIBUTION main- that many of the symbols, traditions,NOT andFOR ritu- SALE OR DISTRIBUTION stream of higher education and was located al- als of the modern university emerged from the most exclusively in hospitals. These hospitals, Church’s influence on these schools. The doc- and the later universities where nursing educa- toral gowns and hoods worn at graduation can © Jonestional & programs Bartlett moved, Learning, were controlled LLC by ad- be traced back© to Jones the garb & worn Bartlett by the priests. Learning, LLC ministrative structures that are best described The English word doctor comes from the NOT FORas highly SALE paternalistic. OR DISTRIBUTION These paternalistic or- Latin word doctus,NOTthe FOR past SALEparticiple OR of docere, DISTRIBUTION ganizations, in juxtaposition with the fact that which means “to teach” (Webster’s New Collegiate most nurses were and still are women, may Dictionary, 1979). Italian schools awarded for- have delayed the profession from adopting doc- mal doctoral degrees by 1219. This was the © Jones & Bartlett toralLearning, degrees as LLC the required credential for pro-© Jonesonly degree & Bartlett offered by Learning,the schools, because LLC they fessional leadership. The profession adopted were preparing teachers. French schools used a NOT FOR SALE ORthe DISTRIBUTION master’s degree early as the appropriate de-NOTslightly FOR different SALE approachOR DISTRIBUTION and chose the name gree for leaders, and this may have been a dis- masters, from the Latin word magister, for their service to the profession. Currently, nursing is college graduates. Graduates from these far from having a unified approach to doctoral schools were awarded the respective title and education.© Jones & Bartlett Learning, wLLCere admitted to the guild of teachers© Jones (Mar tin,& Bartlett Learning, LLC The purpose of this chapter is to briefly dis- 1989). Obtaining a degree meant that the grad- cuss the historyNOT ofFOR doctoral SALE education OR DISTRIBUTION in gen- uate was fully qualified to serveNOT as aFOR teacher SALE OR DISTRIBUTION eral and nursing doctoral programs in and did not need additional evaluation to particular. Clearly, this discussion is not ex- begin this profession. haustive but is intended to provide an intro- In the United States, the early colleges were © Jonesduction & Bartlett to underst Learning,anding doctoral LLC education. established to© prepare Jones clergy & Bartlett and for the Learning, most LLC Other, better historical overviews are available part were built on the English and German sys- NOT FORon the SALE general topicOR ofDISTRIBUTION doctoral degrees (Harris, tems of higherNOT education. FOR HarvardSALE CollegeOR DISTRIBUTION was Troutt, & Andrews, 1980). This chapter also in- founded in 1636, and from that time until the cludes discussion of some of the controversies Civil War, a little more than 200 years later, the that are swirling about how doctoral degrees in only degree that could be earned in the United nursing should be titled and structured and States was the bachelor of arts. Alumni who © Jones & Bartlett concludesLearning, with LLC some ideas that may portend© Jonespaid fees & wereBartlett able to Learning, obtain the master’s LLC de- NOT FOR SALE ORthe DISTRIBUTION future of nursing doctorates. NOTgree FOR without SALE further OR collegiate DISTRIBUTION work. Scientists who wished to obtain additional education had to receive this training in Europe (U.S. A BRIEF HISTORY OF DHEW, 1971). DOCTORAL EDUCATION © Jones & Bartlett Learning, LLCFollowing the Civil War, American© Jones colleges & Bartlett Learning, LLC The academic degrees that we see today are an began to change. Yale awarded the first PhDs in outgrowthNOT of the FOR trade SALE guilds andOR teaching DISTRIBUTIONthe United States in 1861 (Martin,NOT 1989). FOR For SALE OR DISTRIBUTION guilds that flourished in Europe during the the first time, there was an emerging emphasis Middle Ages (U.S. DHEW, 1971). These early on graduate education and the underlying re- programs were often a product of the educa- search that is a part of graduate education © Jonestional & institutionsBartlett Learning, that were either LLC controlled today. Many© of Jonesthe faculty & hadBartlett obtained Learning, their LLC or heavily dominated by the Catholic Church. graduate degrees at German universities. The NOT FORHigher SALE education OR was DISTRIBUTION designed for the elite and German graduateNOT school FOR model SALE did notOR usually DISTRIBUTION

A Brief History of Doctoral Education I 29

include required© Jones class & attendance Bartlett orLearning, examina- LLCof calls to improve this situation.© Jones For example, & Bartlett Learning, LLC tions. Rather, students studied under the direc- Abraham Flexner (1930) argued that the tion of a NOTmajor professor,FOR SALE conducted OR anDISTRIBUTION original American universities had becomeNOT misguidedFOR SALE OR DISTRIBUTION piece of research, and were expected to success- by their focus on preparing PhD graduates for fully defend their work before the standing fac- practice and not for pure learning. He con- ulty of the university to be granted the degree. tended that this had diminished the quality of © JonesHowever, & Bartlett because Learning, graduate education LLC was em- the education.© JonesHis work & in Bartlettgraduate education Learning, LLC bedded in undergraduate colleges, graduate came on the heels of his work on the reform of NOT FORstudents SALE in the OR United DISTRIBUTION States were often re- allopathic medicalNOT FOReducation. SALE By 1935, OR aDISTRIBUTION fairly quired to earn grades and attend lectures. standardized model for PhD education was in In the latter half of the 1800s, several profes- place, and the emergence of various accrediting sional associations were formed to advance bodies ensured that quality standards were met. © Jones & Bartlett Learning,their respective LLC professions. One of their early© JonesMany &PhD Bartlett programs Learning, were closed or LLC merged be- activities was to persuade state legislatures that cause their quality did not meet emerging na- NOT FOR SALE ORthe DISTRIBUTION professional services offered by the variousNOT tionalFOR standards. SALE OR DISTRIBUTION disciplines would be greatly improved by creat- Following World War II, a clear link devel- ing licensure or certification requirements. As a oped between building the knowledge base for part of this effort, educational programs that a specialized field and the award of the PhD led to the© professional Jones & doctorate, Bartlett including Learning, the LLCin that field. For the first time,© the Jones U.S. govern- & Bartlett Learning, LLC doctor of medicine (MD) and the doctor of den- ment allocated funds to the building of the re- tal surgeryNOT (DDS) FOR were SALEdeveloped. OR New DISTRIBUTION medical search needed to create new knowledge.NOT FOR A large SALE OR DISTRIBUTION schools began to offer limited instruction in al- portion of this new money was directed toward lopathic or homeopathic medicine. Although science as a part of the country’s national de- offering a doctoral degree, most of these early fense efforts (Berelson, 1960). © Jonesschools & Bartlett were little Learning, more than LLCdiploma mills In the early© Jones 1950s, a& new Bartlett debate emerLearning,ged LLC with few, if any, paid faculty, very limited in- over whether the PhD should be the degree for NOT FORstruction, SALE and OR substantial DISTRIBUTION reliance on clerk- the professionsNOT orFOR whether SALE the ORprofessions DISTRIBUTION ships with practicing physicians. By the late should use a professional degree such as the 1800s, there were many different types of pro- doctor of education (EdD), the doctor of busi- fessional schools, but there were no accredita- ness administration (DBA), the doctor of public tion standards. Most had limited faculty and health (DPH), or the doctor of nursing science © Jones & Bartlett Learning,questionable curricula.LLC Seldom were these pro-© Jones(DNSc). & TheBartlett professions Learning, believed that LLC the PhD NOT FOR SALE ORgrams DISTRIBUTION more than a year in length, and admis-NOT wasFOR the SALEstandard OR and DISTRIBUTIONwas well understood and sion depended more on the student’s economic aspired toward that degree. Arts and sciences achievements than on the student’s prior acad- faculty believed that awarding a PhD with a spe- emic achievements (U.S. DHEW, 1971). cialty in the professions would diminish the de- Efforts© to Jones standardize & Bartlett curricula began Learning, at the LLCgree. In general, the professions© prevailed Jones in & this Bartlett Learning, LLC turn of the century and continued well into the argument, and the PhD was selected as the ap- 1900s. CallsNOT went FOR out toSALE improve OR professional DISTRIBUTIONpropriate degree. This degree NOTdid carry FOR with SALE it OR DISTRIBUTION education as well as the quality of the PhD. By the concomitant requirement that the comple- 1900, approximately 50 universities in the tion of a satisfactory piece of research was re- United States offered the PhD, but there was al- quired for its award (Berelson, 1960). © Jonesmost & noBartlett quality control. Learning, At the best LLC universities, Professions© Jones that wished & Bartlett to prepare Learning, their LLC the PhD was awarded after about 2 years of practitioners without this research requirement NOT FORpostbaccalaureate SALE OR study.DISTRIBUTION There were a number awarded aNOT professional FOR SALE degree ORsuch DISTRIBUTIONas the

30 I Chapter 3 The Evolution of Doctoral Education in Nursing

doctor of osteopathy© Jones (DO), & Bartlett the doctor Learning, of medi- LLC1920s and 1930s in education departments© Jones and& Bartlett Learning, LLC cine (MD), the doctor of dental surgery (DDS), were tailored to prepare nursing faculty. The the doctorNOT of dental FOR medicine SALE (DMD), OR DISTRIBUTIONthe doc- programs awarded the PhD or EdD,NOT but FOR offered SALE OR DISTRIBUTION tor of pharmacy (PharmD), the doctor of veteri- little, if any, coursework in nursing. nary medicine (DVM), the doctor of optometry In the 1940s and 1950s, baccalaureate pro- (OD), the doctor of chiropractic medicine (DC), grams in nursing were created at a number of © Jonesand &the Bartlett doctor of Learning,podiatric medicine LLC (DPM). universities. Along© Jones with this & moveBartlett came Learning,impor- LLC These professional programs were not consid- tant questions about the qualifications of the NOT FORered graduate SALE programs OR DISTRIBUTION because few of them re- faculty. FacultyNOT qualifications FOR SALE were OR a minor DISTRIBUTION quired an undergraduate degree for admission issue when the program was located in a hospi- and most did not build on undergraduate tal, but most universities held rather strict stan- learning in a specific discipline to prepare for dards for faculty. Few nurses held baccalaureate © Jones & Bartlett theLearning, profession (CAGS,LLC 1966). © Jonesdegrees, & and Bartlett even fewer Learning, held master’s LLC degrees. Almost none held doctoral degrees, and the NOT FOR SALE OR DISTRIBUTION NOTdoctoral FOR degreeSALE was OR the DISTRIBUTION standard for university DOCTORAL PROGRAMS IN AND faculty positions. FOR NURSING This change in locus of nursing education Stevenson and Woods (1986) identified four gave rise to often acrimonious discussions phases in ©nursing Jones doctoral & Bartlett programs. Learning, Doctoral amongLLC faculty at several schools© Jones of nursing & Bartlett Learning, LLC programs in nursing can be thought of as hav- about the need for doctoral education. These ing four generations.NOT FOR The SALE first phaseOR DISTRIBUTIONwas be- discussions often raised the followingNOT questions: FOR SALE OR DISTRIBUTION tween 1900 and 1940, in which the doctor of Should the program of study be focused on the education (EdD) or another functional degree discipline of nursing or a science-related disci- was available. The second phase was between pline? Should the degree not be in education, © Jones1940 & and Bartlett 1960, when Learning, the degree LLC could be ob- since most of© the Jones graduates & would Bartlett be educators? Learning, LLC tained in a basic or social science discipline with Would the master’s degree not be sufficient, par- NOT FORno nursing SALE content. OR DISTRIBUTION The third phase was be- ticularly if theNOT focus FOR of the SALEmaster’s ORdegree DISTRIBUTION was tween 1960 and 1970, when a basic or social sci- clinical nursing? If the new doctoral programs ence PhD was available with a minor in nursing. were to focus on nursing, from where would the The fourth phase began around 1970 with the faculty be drawn, as the number of nurses with rapid proliferation of the DNSc and nursing doctorates in nursing was not sufficient for one © Jones & Bartlett PhDLearning, programs. LLC © Jonesschool faculty,& Bartlett let alone Learning, many schools? LLC NOT FOR SALE OR DISTRIBUTIONThe first research-focused doctoral pro-NOT FORSeveral SALE schools ORdid begin DISTRIBUTION doctoral programs grams in the United States were in various areas in nursing in the 1950s and 1960s. While the of science and did not seek to recruit nurses program at Teachers College continued in specifically. Nurses, as well as any other student, nursing education and nursing administration, could be considered© Jones for & admission Bartlett if Learning,they pos- theLLC program at New York University© Jones reconfig- & Bartlett Learning, LLC sessed the necessary prerequisites. The problem ured the curriculum to focus on nursing as the was that fewNOT nurses FOR at the SALE beginning OR of theDISTRIBUTION 20th science of unitary humans (Rogers,NOT FOR 1966). SALE OR DISTRIBUTION century held an undergraduate degree. Basic Boston University designed the first program nursing education was hospital based and did to deal with the clinical practice of nursing not award degrees. and created the doctor of nursing science de- © JonesThe & Bartlettfirst doctoral Learning, programs that LLC specifically gree, with the© Jonesfirst graduate & Bartlett in 1963. Learning, The LLC recruited nurses were at Columbia University University of California at San Francisco and NOT FORand New SALE York ORUniversity. DISTRIBUTION These began in the the CatholicNOT University FOR of SALE America OR followed DISTRIBUTION

Doctoral Programs In and For Nursing I 31

Boston University’s© Jones lead & Bartlettand established Learning, doctor LLCGrants Program. The purpose© ofJones these grants & Bartlett Learning, LLC of nursing science programs shortly thereafter. was to increase the research capabilities of The UniversityNOT ofFOR Pittsburgh SALE created OR DISTRIBUTIONa PhD in faculty in graduate nursing programsNOT FOR by pro- SALE OR DISTRIBUTION clinical nursing around this same time. The viding seed money. Eighteen institutions qual- University of Alabama at Birmingham devel- ified for these grants between 1959 and 1968. oped a doctor of science in nursing (DSN) Of these 18 programs, only three offered doc- © Jonesshortly & Bartlett thereafter, Learning, and it was designed LLC similarly toral programs© Jones in nursing & Bartlett during the Learning, grant- LLC to the DNSc (Kelly, 1978). funding period (1 PhD, 1 EdD, and 1 DNSc) NOT FORA SALEserious ORproblem DISTRIBUTION remained, however, in (Martin, 1989).NOT FOR SALE OR DISTRIBUTION that many of the key players concluded that In another attempt to increase the number nursing science was not of sufficient maturity of nurses with doctoral degrees, the Division of to justify the PhD. Of course, no measure of sci- Nursing began to fund the nurse scientist grad- © Jones & Bartlett Learning,entific maturity LLC was advocated. Perhaps this© Jonesuate training & Bartlett grants. Learning,The intent of thisLLC program problem grew from the fact that most nurses was to build a cadre of nurses with doctoral de- NOT FOR SALE ORwith DISTRIBUTION doctorates at this time had obtained theirNOT greesFOR at SALEuniversities OR and DISTRIBUTION to increase the number degrees in another discipline. Those disciplines of nursing doctoral programs. Funding was de- had the appearance of maturity because they of- signed to assist nurses in obtaining doctoral de- fered a doctorate. These nurses had not spent grees in fields that were viewed as related to their doctoral© Jones study &in Bartlettnursing because Learning, such LLCnursing. These fields included© such Jones areas as& so Bartlett- Learning, LLC doctoral study was not widely available. ciology, psychology, anthropology, biology, and Further, NOTsome of FOR the writings SALE of OR the period DISTRIBUTION dis- physiology, with the expectationNOT thatFOR there SALE OR DISTRIBUTION play a rather romantic and narrow view of what would be coursework or a minor in nursing. constituted science. Nursing research texts pro- Nine universities representing 34 different de- posed that science was logical and orderly, when partments received these grants. Four of the © Jonesin practice& Bartlett this is Learning,seldom the case. LLC Some called nine universities© Jones had doctoral& Bartlett programs Learning, in LLC for nursing practice to be derived from science, nursing at the time, but these were not eligible NOT FORand yetSALE few scientists OR DISTRIBUTION would argue that practice for receipt ofNOT this fundingFOR SALE (Martin, OR 1989). DISTRIBUTION is derived from science (McManus, 1960). Beginning in the early 1970s, several new Funds from the federal government helped a doctoral programs in nursing emerged. These number of nurses to obtain doctoral degrees, new programs were most often in the older, which may have contributed to the continuing more established schools of nursing. Growth © Jones & Bartlett Learning,debate over whether LLC the doctoral degree should© Jonescontinued & Bartlett through theLearning, 1980s and LLC1990s, with NOT FOR SALE ORbe DISTRIBUTION in nursing or a different field. In 1955, theNOT sevFOReral newSALE programs OR DISTRIBUTION opening each year. The United States Public Health Service started pace of new program development was often funding doctoral study through the federal faster than the available faculty would have pre- Predoctoral Research Fellowship Program. dicted would be the case. In 1970, there were 20 Funds were© Jones awarded & directly Bartlett to the Learning, doctoral LLCprograms, but by 2000 there© were Jones 78 (AACN, & Bartlett Learning, LLC student, and several aspiring faculty members 2002). Most of the research being conducted in were ableNOT to fund FOR their SALEeducation OR through DISTRIBUTION this these schools was done by students.NOT FOR Funding SALE OR DISTRIBUTION mechanism. Between 1955 and 1970, 156 for nursing research in these schools was rare. nurses were supported by Division of Nursing The most common degree offered was the PhD, fellowships (Grace, 1978). Almost none of these but several schools offered the DNSc or the © Joneswere & inBartlett nursing. Learning, LLC DSN. Doctoral© Jones education & Bartlett in nursing Learning, became LLC Beginning in 1959, the Division of Nursing widely available throughout the United States NOT FORalso SALEfunded the OR Faculty DISTRIBUTION Research Development during thisNOT time. FOR SALE OR DISTRIBUTION

32 I Chapter 3 The Evolution of Doctoral Education in Nursing

New approaches© Jones to & delivery Bartlett of the Learning, curricu- LLCates and prepared them to be nurses© Jones at a level & Bartlett Learning, LLC lum became available as well. Some schools of- similar to other health professional doctoral fered a summersNOT FORoption, SALE in which OR courses DISTRIBUTION were programs, such as medicine, veterinaryNOT FOR medi- SALE OR DISTRIBUTION scheduled during the summer months when cine, dentistry, optometry, and others. The cre- faculty in nursing schools who needed the doc- ation of this clinical program at the very time toral degree could participate. Other schools of- that nursing was struggling with building the © Jonesfered & weekendBartlett programs, Learning, and LLC Web-based research enterprise© Jones and research-focused& Bartlett Learning, doc- LLC distance learning programs emerged as well. torates was not accepted with universal agree- NOT FORInterestingly, SALE the OR rapid DISTRIBUTION increase in the number ment. Of someNOT concern FOR was SALE how this OR program DISTRIBUTION of programs and the development of creative would be different from the DNSc. Up to this ways to deliver the curriculum did little to in- time, there had been the assumption that the crease the number of graduates each year. PhD was to focus on scholarly research and the © Jones & Bartlett Learning,This rapid growth LLC and creativity in curricu-© JonesDNSc was& Bartlett to be the practice-oriented,Learning, LLC clinical lum delivery were partly responsible for the degree. Yet, studies had shown that the DNSc NOT FOR SALE ORdevelopment DISTRIBUTION of new standards for doctoral pro-NOTcould FOR not SALE be distinguished OR DISTRIBUTION from the PhD on grams. The American Association of Colleges of the basis of admission standards, curriculum, Nursing created a set of quality indicators for or dissertation topics (Flaherty, 1989). For the research-focused doctoral programs in nursing first time, nursing had a doctoral degree that (AACN, 1993).© Jones These &indicators Bartlett became Learning, the wasLLC open to non-nurses and that© Jonesprepared &the Bartlett Learning, LLC standard for evaluation of these programs. beginning clinician at the doctoral level. The rapidNOT proliferation FOR SALE of programs OR DISTRIBUTION did not Additional clinical doctoralNOT programs FOR were SALE OR DISTRIBUTION create a concomitant increase in the number of developed at Rush University, the University of graduates. The new programs were small (aver- Colorado, and the University of South Carolina. aging six graduates per year), and the length of Today, most of these programs provide multi- © Jonestime & to Bartlettobtain the degreeLearning, continued LLC to be long, ple entry points© Jones reflective & of Bartlettthe diverse Learning,nature LLC primarily because of the number of part-time of nursing practice. Each of these programs pre- NOT FORstudents. SALE Even OR though DISTRIBUTION the number of pro- pares the clinicianNOT at FOR the doctoral SALE level OR to DISTRIBUTION exert grams had increased from 20 to 78, there were leadership in evidence-based practice, health only 200 more graduates in 1998 than in 1989, policy, and management or education. These and most of that growth occurred prior to new programs created quite a stir, and one that 1992 (AACN, 2003). Clearly, these research- the profession has yet to resolve. In 1963, when © Jones & Bartlett focusedLearning, doctoral LLC programs could not be ex-© Jonesthe first & DNSc Bartlett was awarded, Learning, the profession LLC had NOT FOR SALE ORpected DISTRIBUTION to meet the needs for nursing facultyNOT assumed FOR SALEthat the firstOR clinical DISTRIBUTION doctorate had ar- because of the small numbers and the fact that rived. But close inspection of the program all graduates did not assume faculty positions showed that the DNSc curriculum required after graduation. Also, the median age of the mastery within a field of knowledge and graduates ©at Jonescompletion & Bartlettof the doctorate Learning, was demonstratedLLC ability to perform© Jonesscholarly &re- Bartlett Learning, LLC older than 45 years. search—the very characteristics of the PhD NOT FOR SALE OR DISTRIBUTION(Standing & Kramer, 2003). TheNOT ND, FOR in con- SALE OR DISTRIBUTION CLINICAL DOCTORAL PROGRAMS trast, focused exclusively on preparing a clinical In 1979, the Frances Payne Bolton School of leader, not a researcher. Nursing at Case Western Reserve University The clinical doctoral programs to some © Jonesbegan & aBartlett new approach Learning, to doctoral LLC education in extent reflected© Jones the tremendous & Bartlett changes Learning, LLC nursing (Standing & Kramer, 2003). Originally that were taking place in the clinical practice NOT FORconceived SALE as a firstOR professional DISTRIBUTION degree, the doc- of nursing. TheNOT early FOR beginning SALE of OR the nurseDISTRIBUTION tor of nursing (ND) was open to college gradu- practitioner and clinical nurse specialist © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

Future Doctoral Education I 33

movements© Jones had taken & place. Bartlett New master’s Learning, pro- LLCFUTURE DOCTORAL EDUCATION© Jones & Bartlett Learning, LLC grams were opening each year, and the major The future of research-based doctoral programs thrust ofNOT these FOR programs SALE was OR on advancedDISTRIBUTION NOT FOR SALE OR DISTRIBUTION in nursing is not likely to be much different nursing practice. State laws were changing, and from the recent past. No mechanisms are in advanced practice nurses were obtaining place to determine how many programs there greatly expanded scopes of practice and pre- should be or to enforce quality standards at scriptive privileges. Most of these new master’s © Jones & Bartlett Learning, LLC these programs.© Jones The demand & Bartlett for nursing Learning, fac- LLC programs were between 18 months and 2 years ulty in the future is acute, and this will likely NOT FORin length. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION drive the creation of many more programs. Concern among some faculty was building Nursing has not been susceptible to the re- that the length and rigor of these master’s pro- quirement seen in other disciplines that the fac- grams needed to be improved and that the grad- ulty should be engaged in funded research prior uate should earn a doctorate. Yet, the doctorate © Jones & Bartlett Learning, LLC © Jonesto offering & Bartlett a research Learning, degree. Most LLC schools of- needed to be focused in clinical practice. This NOT FOR SALE ORposition DISTRIBUTION was consistent with the Council onNOT feringFOR theSALE nursing OR PhD DISTRIBUTION cannot be considered Graduate Schools’ position that “the profes- research-intensive schools. sional doctor’s degree should be the highest The decision of a school to offer the PhD university award given in a particular field in versus the DNSc often has been primarily a political decision. The PhD is often governed by recognition© Jones of comple &tion Bartlett of academic Learning, prepara- LLC © Jones & Bartlett Learning, LLC tion for professional practice” (CAGS, 1966, the rules of the graduate school in addition to p. 3). TheNOT schools FOR that SALE created OR the DISTRIBUTIONND pro- the nursing school, and this mayNOT mean FOR that ap-SALE OR DISTRIBUTION grams were noted for their outstanding clinical proval would be more problematic. Some master’s programs. This new degree could be schools (such as the University of California at viewed as a logical extension of their programs. San Francisco, the University of Pennsylvania, and Indiana University) began their doctoral © Jones &Nursing Bartlett educators Learning, have not LLCuniversally ac- © Jones & Bartlett Learning, LLC cepted the ND program. As Standing and programs as DNSc programs and later con- NOT FORKramer SALE (2003) OR point DISTRIBUTION out, reviews of nursing verted themNOT to the FOR PhD. Only SALE two schoolsOR DISTRIBUTION have doctoral graduates published in the literature begun PhD programs and then added DNSc almost always ignore the graduates of such pro- programs—the University of Tennessee Health grams even though nearly 700 nurses hold this Science Center and Johns Hopkins University. degree. The basis for ignoring or discounting In general, faculty prefer the PhD; therefore, it © Jones & Bartlett Learning,these programs LLC is not clear. The need for the© Joneswill likely & Bartlett continue to Learning, be the preferred LLC degree in NOT FOR SALE ORclinical DISTRIBUTION doctorate is clearly documented, andNOT theFOR future. SALE OR DISTRIBUTION the demand for the scarce slots in these pro- However, the world of clinical doctorates is grams is also clear. quite different. The other major health profes- Recently, the University of Kentucky began a sions have offered the clinical doctor’s degree for a number of years. For example, pharmacy is the new clinical© Jones doctoral & program, Bartlett the Learning, doctor of LLC © Jones & Bartlett Learning, LLC nursing practice (DNP). On close inspection, most recent profession to mandate the doctorate this programNOT shares FOR many SALE of the OR same DISTRIBUTION curricu- as the single degree for its professionalNOT FOR practice. SALE OR DISTRIBUTION lar components as the ND programs. An addi- Nursing, the largest health profession, continues tional planning group has met for several years to prepare its beginning practitioners at less than to build a consensus for the development of ad- the baccalaureate level. Attempts to alter this sit- © Jonesditional & Bartlett doctor of Learning, nursing practice LLC programs at uation, even© in Jones light of important & Bartlett evidence Learning, of the LLC senior universities. However, the distinctions value of higher education, have failed. What is NOT FORbetween SALE the doctorOR DISTRIBUTION of nursing practice and the emerging, however,NOT FOR is a de SALE facto second OR DISTRIBUTIONlicense doctor of nursing are far from clear. for nursing, the advanced practice license. This © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

34 I Chapter 3 The Evolution of Doctoral Education in Nursing

new license© mayJones accelerate & Bartlett the development Learning, of LLCclinical doctoral program. These© programsJones &are Bartlett Learning, LLC the clinical doctorate. faculty intensive, require interdisciplinary NursingNOT chose FOR the master’s SALE degreeOR DISTRIBUTION as the coursework with the other majorNOT health FOR profes- SALE OR DISTRIBUTION minimum preparation for advanced practice. sions, and are costly to operate. Schools of nurs- The master’s degree in the United States has al- ing must have a substantial clinical practice ways been an unusual degree—more than the operation to be able to mount such a program. © Jonesbaccalaureate & Bartlett but lessLearning, than the doctorate, LLC and These new programs© Jones will prepare& Bartlett highly compe-Learning, LLC usually discipline specific. This degree is un- tent clinicians for such roles as primary care NOT FORcommon SALE in the OR major DISTRIBUTION health professions, at provider for cross-siteNOT FOR practice; SALE midwifery OR DISTRIBUTIONprac- least as a professional degree. This degree desig- tice that includes surgical abilities to perform nation is used for the master of public health cesarean sections; anesthesia providers to ad- and the master of hospital administration, but minister all forms of anesthesia, including © Jones & Bartlett theLearning, other health LLC professions use a nondegree,© Jonesintrathecal & Bartlett approaches; Learning, as well as national LLC and postdoctoral training period to prepare their international leaders in policy formulation, com- NOT FOR SALE ORspecialists. DISTRIBUTION Reasons as to why nursing adoptedNOTplex FOR organizational SALE OR administration, DISTRIBUTION and master the master’s degree are somewhat obscure, but clinical teachers. These roles cannot be achieved are likely related to political considerations. by obtaining a research-focused doctoral degree, Nursing’s history of hospital-based education and certainly not by way of the master’s degree. rather than© degree-based Jones & educationBartlett meant Learning, that LLC © Jones & Bartlett Learning, LLC much of nursing was left out of the advances in CONCLUSION higher educationNOT FOR during SALE the 20th OR century.DISTRIBUTIONDoctoral education in the UnitedNOT States FOR under- SALE OR DISTRIBUTION While medicine, dentistry, and, to some extent, went dramatic changes during the 20th century pharmacy were able to strengthen their educa- and will likely continue to evolve over the next tional programs within the university tradition, century. Nurses were once educated outside the © Jonesnursing & Bartlett was still knockingLearning, at the LLC door. Few mainstream of© higherJones education, & Bartlett but following Learning, LLC women were able to obtain a college education World War II the locus of nursing education NOT FORuntil wellSALE after OR World DISTRIBUTION War II. The idea that was moved toNOT the university.FOR SALE This OR trend DISTRIBUTION has nursing should have a clinical doctoral degree brought with it the need for a faculty commen- similar to the other health fields would not surate with that of the rest of the university. For have entered the minds of most academics, and the arts and sciences, that meant the PhD de- certainly not most nurses, until recently. gree; for the professional schools, it has meant © Jones & Bartlett Learning,Today, however, LLC we see advanced practice© Jonesthe clinical & Bartlett doctorate. Learning, LLC NOT FOR SALE ORnurses DISTRIBUTION in roles that were unthinkable just a fewNOT FORNursing SALE was a ORbit slow DISTRIBUTION to embrace the idea years ago. Independent nursing practices in in- that nursing faculty would need the research stitutions and communities are making sub- doctorate. But once the idea was adopted, many stantial changes in the way health care is schools—some would argue too many schools— delivered. The© Jones kind of education & Bartlett that theseLearning, clin- rapidlyLLC developed these programs.© JonesThere is still& Bartlett Learning, LLC icians will need for the future cannot be a reluctance to move to the development of the achieved inNOT today’s FOR master’s SALE programs. OR DISTRIBUTIONThe fu- clinical doctorate on a broad scale.NOT The FOR poten- SALE OR DISTRIBUTION ture advanced practice nurses will need a mini- tial for this degree to alter the power and politi- mum of a clinical doctoral degree and most cal relationships between nursing and other likely will require substantial postdoctoral professions, however, is substantial. © Jonestraining & Bartlett in narrow Learning,specialties. LLC The clinical© doctorateJones can& Bartlett provide a skill Learning, and LLC Not every school that currently offers the science base for the graduate that cannot be NOT FORmaster’s SALE degree OR will haveDISTRIBUTION the faculty, clinical ma- achieved in today’sNOT educationalFOR SALE programs. OR DISTRIBUTION This terial, or other requisite resources to offer the level of expertise will be critical as the nation © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

References I 35

focuses on© improvingJones & patient Bartlett care and Learning, the safety LLCBerelson, B. (1960). Graduate education© Jones in the United& Bartlett Learning, LLC of the systems that deliver health care. Clearly, States. New York: McGraw-Hill. the clinicalNOT doctorate FOR will SALE bring withOR it DISTRIBUTION a level of Council of Graduate Schools (CGS)NOT in FORthe United SALE OR DISTRIBUTION States. (1966). The doctor’s degree in professional fields: independent practice that cannot be achieved at A statement by the Association of Graduate Schools and less than the doctoral level. For the first time, the Council of Graduate Schools in the United States. nursing would have parity in educational prepa- Washington, DC: Author. © Jonesration & Bartlettwith other healthcareLearning, disciplines. LLC Council of Graduate© Jones Schools & Bartlett (CGS) in the Learning, United LLC Nursing is the most comprehensive of all the States. (1990). The doctor of philosophy degree: A policy NOT FORhealth SALE professions. OR DISTRIBUTION Clinical practice demands statement. NOTWashington, FOR DC: SALE Author. OR DISTRIBUTION of nursing clinicians an understanding of the Flaherty, M. J. (1989). The doctor of nursing science degree: Evolutionary and societal perspectives. In human condition, the environments in which S. E. Hart (Ed.), Doctoral education in nursing: clients live, the systems of care delivery, and the History, process, and outcome (pp. 17–31). New York: © Jones & Bartlett Learning,political milieu LLC of care. Preparation of clinical© JonesNational & Bartlett League for Learning, Nursing. LLC leaders fundamentally requires a doctoral de- Flexner, A. (1930). Universities: American, English, NOT FOR SALE ORgree. DISTRIBUTION The time is now for the discipline NOTto FORGerman. SALENew York: OR Oxford DISTRIBUTION University Press. move to the clinical doctorate to complement Grace, H. (1978). The research doctorate in nursing. In Proceedings of the 1978 Forum on Doctoral Education in the many substantial accomplishments that Nursing (pp. 40–59). Chicago: Rush University. have taken place by the creation of the research- Harris, J., Troutt, W., & Andrews, G. (1980). The focused doctorates.© Jones & Bartlett Learning, LLCAmerican doctorate in the context© ofJones new patterns & Bartlettin Learning, LLC higher education. Washington, DC: Council on Post DISCUSSIONNOT QUESTIONSFOR SALE OR DISTRIBUTIONSecondary Accreditation. NOT FOR SALE OR DISTRIBUTION Kelly, J. (1978). The professional doctorate in nursing 1. Visit the website of the American Association from the viewpoint of nursing service. In of Colleges of Nursing and specialty organi- Proceedings of the 1978 Forum on Doctoral Education in zations. Read the most recent update on the Nursing (pp. 10–39). Chicago: Rush University. © Jones &clinical Bartlett doctorate. Learning, Visit the LLCsites of several Martin, E. J. (1989).© Jones The doctor & Bartlett of philosophy Learning, degree: LLC NOT FORuniv SALEersities OR and DISTRIBUTION compare and contrast the EvolutionarNOTy and FOR societ alSALE perspectives. OR DISTRIBUTIONIn S. E. similarities and differences of doctoral pro- Hart (Ed.), Doctoral education in nursing: History, grams throughout the United States. process and outcome (pp. 1–16). New York: National League for Nursing. 2. What are the pros and cons of requiring doc- McManus, L. (1960). Doctoral education in nursing: toral education for advanced practice in A nurse educator responds. Nursing Outlook, 8, © Jones & Bartlett Learning,nursing? IncludeLLC personal, professional,© Jones543–546. & Bartlett Learning, LLC healthcare, and societal perspectives. Rogers, M. (1966). Doctoral education in nursing. NOT FOR SALE OR DISTRIBUTION NOT FORNursing SALE Forum, 5OR(2), 75–82. DISTRIBUTION Standing, T. S., & Kramer, F. M. (2003). The ND: REFERENCES Preparing nurses for clinical and educational lead- American Association of Colleges of Nursing (AACN). ership. Reflections on Nursing Leadership, 29(4), (1993). AACN position statement: Indicators of quality 35–37, 44. in doct©oral Jones programs in& nursing. BartlettWashington, Learning, DC: LLCStevenson, J. S., & Woods, N. F. (1986).© Jones Nursing science & Bartlett Learning, LLC Author. and contemporary science: Emerging paradigms. AmericanNOT Association FOR SALEof Colleges OR of DISTRIBUTION Nursing In G. E. Sorensen (Ed.), Setting theNOT agenda FOR for the yearSALE OR DISTRIBUTION (AACN). (2002). Indicators of quality in research- 2000: Knowledge development in nursing (pp. 6–20). focused doctoral programs in nursing. Retrieved Kansas City, MO: American Academy of Nursing. September 19, 2007, from http://www.aacn.nche U.S. Department of Health, Education, and Welfare .edu/Publications/positions/qualityindicators.htm (U.S. DHEW). (1971). Future directions of doctoral ed- © JonesAmerican & Bartlett Association Learning, of Colleges LLC of Nursing ucation for© nurses. Jones (U.S. & DHEW Bartlett Publication Learning, No. LLC NOT FOR(AACN). SALE (2003). OR IndicatorsDISTRIBUTION of quality in research- [NIH] 72–82).NOT Bethesda, FOR MD:SALE Author OR. DISTRIBUTION focused doctoral programs in nursing. Journal of Webster’s New Collegiate Dictionary. (1979). Springfield, Professional Nursing, 18(5), 289–294. MA: Merriam-Webster. © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION