Nurses: which doctorate?

Nurses wishing to undertake doctoral level studies have a wide array of programmes to choose from internationally; however, choosing which one to undertake requires careful thought as each type of doctorate has its unique features related to mode of study, length of programme and method of examination.   In addition, with some programmes there are part-time options and, while these permit some flexibility, they also extend the time taken. 

PhD

The best known type of doctorate is the PhD or Doctor of Philosophy and this can be taken in most countries; albeit that the PhD varies greatly between them.  The PhD is designed for people who wish to undertake a prolonged period of research with a view to becoming an independent researcher.  It is a fact that most people with PhDs eventually work in universities.

In the UK the full-time PhD traditionally takes three years with a maximum time of four years.  While some formal study is usually required alongside the research project, the main mode of study is by independent but supervised research leading to the production of a substantial thesis (50-100,000 words) and an examination by and oral examination or viva voce—a process involving interview by at least two examiners; one external to the university where the PhD has been taken and this is a process whereby the student ‘defends’ their work.  There are variations on this model of PhD in the UK such as PhD by publication, but they are very rare.  Rarely is the PhD completed at the viva voce; examiners may ask for substantial revisions and allocate some more time to complete them.

In some parts of Europe—principally The Netherlands and Scandinavia—PhDs are undertaken by publication.  This involves undertaking independent but supervised research, sometimes several small but interrelated projects, leading to the publication of several papers in refereed journals and writing up a small thesis to show how the work fits together.  This type of PhD can take many years to complete as is dependent on achieving good publications.  The final examination involves a judgement by a panel in the university and then a public defence—which anyone may attend—involving an external examiner; this can be a daunting prospect.

The North America PhD usually takes three years to complete and the research component is preceded by a lengthy period of study and assessed courses which have to be passed.  The research work is closely supervised by a committee and the final thesis is quite small compared with a UK PhD.  There is a final oral examination but there are also several steps along the way involving oral examination, therefore, the final examination is not as daunting as the UK viva or the European public examination.

Australian PhDs are very similar to the UK in the style in which they are undertaken and in the substance of the final thesis.  However, the final examination is not by viva; the thesis is sent out to several experts in the field and it is marked and the university decides the outcome based on these marks.

Professional taught doctorates

The range of professional taught doctorates is large and growing across the world.  The precise details of each need to be examined carefully as these differ with the nature and purpose of the taught doctorates.  This type of doctorate leads to the award of a variety of degrees with the title of ‘doctor’ in them and nursing is now at the forefront of their development.  Taught doctorates are usually taken part-time and are designed for professionals who wish to undertake some research but mainly to undertake advanced study in their field of work and to seek career advancement.  Such people are usually quite senior in their field.  Therefore, the period of study in a taught doctorate is formal and has to be passed before going on to the research component.  The latter is usually shorter than a period of PhD study and the kinds of problems investigated are usually directly relevant to the work of the person underrating the doctorate.  Some taught doctorates are specifically for nurses and others are for a range of health professionals.

In the USA some universities are running the Doctorate in Nursing Practice (DNP) and this has been developed specifically for nurses in practice who do not wish to undertake a PhD but who wish to remain in practice and to undertake study and gain accreditation that is directly related to their work and which allows them to remain in work.  There are many taught doctoral programmes in the UK and they are rapidly being developed in Australia.

The next steps

If you are a nurse and you wish to undertake doctoral level study you should:

Think very carefully about it

• Ask yourself why you wish to study and have a degree at the doctoral level
• Decide if you want to have a career in research or to remain in practice
• Find out as much as you can about a range of doctorates
• Investigate, in detail, what specific programmes of interest offer you

Finally, in addition to educational and professional considerations, make sure that you have considered the personal and financial consequences of committing yourself to several further years of study and hard work.

Degree education for nurses

This posting appears as an article in the Times Higher Education of 28 July 2011 in a slightly edited format.  You can leave a comment here or on the blog in THE at http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=416935&c=1

Nursing in higher education

Degree education for nurses has been available in the UK since the 1960s, and other countries long ago made the transition to an all graduate profession.  Nursing in the UK has completed the transition, with the move to degree entry to the nursing register, but the questioning in the press, by politicians and by many in the profession about the necessity for this, and the view that university educated nurses are ‘too posh to wash’, has muted the celebrations.

                                    

Perceived incongruence between being a caring professional and being academically qualified is uniquely applied to nursing – not to medicine, clinical psychology or any of the therapies.  The ridicule heaped on nursing degrees, generally, and doctorates in nursing especially, outweighs any of the opprobrium that is directed at degrees in media, tourism, and leisure studies.

Sunday broadsheet columnists such as Minette Marrin correlate declining standards of care in the NHS with the rise in degree educated nurses and has suggested that young girls who are ‘not particularly bright’ need something to do – and nursing is perfect; why saddle them with having to know anything?  Nursing is viewed as only as skilled caring work by many; indeed, a great deal of what the general public understands to be nursing can and is done by non-professionals.  Confusion arises because nurses also do some of this work and many people think that is all there is to it – wipe a few bottoms; make a few beds…report to the doctor.

Nursing is a complex subject reflecting the complexity of the job.  Biology, psychology, medicine, pharmacology and – to the horror of many – sociology, all contribute to the unique mixture that is nursing.  Clearly, nurses need to know how the body works in health and illness and how it responds to treatment; nurses – as do doctors – need to be able to contextualise their work, thus the sociology.  Nurses need to understand why children with a chronic illness living on a sink estate have different needs in terms of health education than the children of middle class parents.  Are they stupid; don’t they care, or do they just have competing pressures and fewer role models?  The more you know, the less judgemental you will be.  The less judgmental care is, the greater its effect.

If the need for sociology in the curriculum is not compelling, then work from the USA by Professor Linda Aiken at the University of Pennsylvania should be. Aiken unambiguously demonstrates the positive relationship between rescuing deteriorating patients and the number of graduate nurses employed in a hospital.  Also, Australia has had an all graduate entry to the register for decades and, while this is in danger of being eroded on economic grounds, the principle has never been questioned inside or out of the profession.

How does nursing fare as an academic subject?  In the UK in 2008 we rose from the foot of the Research Assessment Exercise table and demonstrated that some of our top schools of nursing were conducting world leading research; in some universities, nursing outstripped medicine.  My own journal, the Journal of Clinical Nursing, amongst others, publishes research that is picked up regularly by the BBC Health pages, Reuters and UK broadsheet newspapers.  This research is directly relevant to patient care and uses sophisticated designs and analyses akin to any research in the medical and social sciences.  Nursing research is cited in medical journals such as the BMJ and The Lancet.

The view that university educated nurses all aspire to be ‘high flyers’ and move away from direct patient care or work in more ‘glamorous’ areas of nursing was dispelled many years ago in follow-up studies of the early graduates from Edinburgh, Manchester and Hull.  Largely, they remained clinically focused and frequently worked with older people and in the community.  However, those who comment freely and negatively on nursing operate in an evidence-free zone and prefer to perpetuate, rather than dissolve, these myths. 

I entered nursing following a BSc in biological sciences (Edinburgh) and a PhD in biochemistry (Sheffield) long before degree education was the norm.  I found the study and the work mentally, physically and emotionally challenging.  I don’t recall my ability to care being impeded by my university degrees but I know that my knowledge of the biology of the skin helped me to treat pressure ulcers and my understanding of research enabled me to design a study which helped inform the management of urinary incontinence.  All nursing is skilled work; good nursing requires academic ability as well as skill.

Roger Watson is Professor of Nursing, University of Sheffield and University of Western Sydney.