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Assessing nursing student intent for PHD study
YNEDT-02602; No of Pages 6 Nurse Education Today xxx (2013) xxx–xxx
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Assessing nursing student intent for PHD study Allison Squires a,⁎,1, Christine Kovner a, Farida Faridaben a, Deborah Chyun b a b
New York University College of Nursing, 726 Broadway, 10th Floor, NY, NY 10003, USA Former chair of the Florence S. Downs PhD Program in Nursing Research and Theory Development and current Executive Associate Dean at New York University College of Nursing, USA
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Article history: Accepted 5 September 2013 Available online xxxx Keywords: Nursing education Bachelor's in nursing Doctoral study Graduate education in nursing Survey Nursing faculty
s u m m a r y Background: Nursing faculty shortages threaten a country's ability to produce the amount of nurses necessary to sustain the delivery of healthcare services. Programs that “fast track” graduate education options for registered nurses are one solution to the problem. Objectives: To 1) evaluate admission criteria into PhD programs for direct entry from a bachelor's degree; 2) ascertain bachelors and masters degree nursing students' perspectives on pursuing a BSN to PhD course of study; 3) clarify factors that influence students' decision-making processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study; 4) to test the survey questions to develop an instrument for future use. Design: A cross-sectional pilot study. Setting: A nursing program at a large urban university in the United States of America with an enrollment of over 1400 students. Participants: Currently enrolled bachelor's, master's, and doctor of nursing practice students. Methods: Students were sampled via a 10-question (including one open-ended question) electronic mail survey that included 1385 eligible subjects. Results: Among the 606 respondents (57% response rate), 63% were between ages 18 and 30 and 87% indicated that full tuition funding with a living stipend would make them more interested in pursuing a PhD. Current program track was a significant predictor of course of study and area of interest (p = .029). Analysis of the 427 respondents to the open-ended question revealed themes around “time” and “money” as the main barriers to study. The desire to gain clinical experience prior to PhD study was the third theme and an unanticipated finding. Conclusions: The questionnaire offered some predictive ability for gauging intent to study for a PhD among bachelor's and graduate degree prepared nurses. The results do offer some suggestions for nursing workforce development to help address faculty shortages. © 2013 Elsevier Ltd. All rights reserved.
Introduction Reducing nursing faculty shortages to ensure the steady production of entry-level, registered nurses (RN) to work in the healthcare system ultimately depends upon RNs with bachelor's degrees (BSN) to return to school for graduate study (Nardi and Gyurko, 2013). For many countries, the PhD level is the preferred preparation for faculty, although some countries may need to focus on bachelor's or master's level preparation of faculty before PhD preparation becomes a faculty norm. Doctorally prepared faculty are also those most likely to contribute to nursing science development and health research, thereby ensuring nursing's voice in the evidence for practice. Overall, for capacity building and health systems strengthening, nurses with research skills provided by PhD preparation are essential.
⁎ Corresponding author. E-mail address: [email protected] (A. Squires). 1 Tel.: +1 212 992 7074.
Bachelor's-to-PhD educational programs are one way to address a nursing faculty shortage. These programs take candidates as: 1) direct entry from the initial BSN entry-level program, 2) diploma or associate/technical degree nurses with previous work experience who are enrolled in a bachelor's completion program (known in the United States as an “RN-to-BSN” program), or 3) nurses with BSNs who have practiced and want to go straight through for a PhD without completing a master's degree prior to matriculation into the PhD program. With these matriculation patterns in mind, this pilot study had three goals. First, we explored admission criteria across universities in the United States (US) that have BSN to PhD programs. This step allowed us to evaluate how the profession in the US appears to address the issue. Then we aimed to ascertain bachelor's and master's degree nursing students' perspectives on pursuing a BSN to PhD course of study. Third, we sought to clarify factors that influence students' decisionmaking processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study. The final aim of the study was to test the survey questions to develop an instrument for future studies. Our overall goal was to address the gaps in the
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Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
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literature on the subject and develop an instrument that could potentially provide useful institutional, regional, or national data for policies aimed at nursing faculty workforce development.
Background Despite periodic alerts about nursing faculty shortages in the literature (Berlin and Sechrist, 2002; De Young and Bliss, 1995; Nardi and Gyurko, 2013), we could not locate a study evaluating nursing students' intent to pursue PhDs in nursing. Of studies related to the question of interest, Cohen (2011) studied nurses already in PhD programs and their process of completion. Plunkett et al (2010) studied a small sample of Canadian students to examine the relationship between perceived self-efficacy and intent for PhD study and found the two strongly correlated (r = .52). Loomis et al. (2007) discerned some of the decisionmaking processes behind choosing between a clinical doctorate that does not have a research focus (known as a Doctor of Nursing Practice in the US) and a PhD course of study, with “life factors” (i.e. familial commitments, age of children, partner's employment status, etc.) serving as a significant factor for most nurses when choosing which degree to pursue. The United States' Institute of Medicine produced a highly influential report about the “Future of Nursing” in the US and it has made a global impact as a policy document (Institute of Medicine, 2011). Recommendation number 5 from the report advocates doubling the number of doctorally prepared nurses in the US by 2020 to ensure enough faculty are available for sustainable production of nursing human resources (Institute of Medicine, 2011). Furthermore, the committee recommends that evaluators monitor each school's graduates of bachelor's degree programs in nursing and ensure that at least 10% of the graduates matriculate into a graduate program within five years of graduation (Institute of Medicine, 2011). The Committee also calls for expanded funding for accelerated graduate study for nurses and urges trustees to increase nursing faculty salaries as an additional incentive to RNs to pursue graduate studies. Some of these policy recommendations can apply to the nursing profession in other countries. Even in light of the IOM “Future of Nursing” report, there is no consensus in the US nursing community about the value of BSN to PhD programs. Mason wrote against the direct-entry BSN to PhD study option because these graduates would never have worked as direct care providers (Mason, 2003). According to Mason, these RNs would not be qualified to teach entry-level nurses in core clinical courses because of a lack of “real world” patient care experience. Another argument is if patients are the source of “inspiration” for nursing research, nurses should have some experience with patients to create better quality and patient relevant research questions and studies. Olshansky (2004), however, in an editorial in response to Mason argued in favor of direct-entry BSN to PhD programs because they provide a vehicle for students who already know they want a research career to begin it quickly. She argued that graduates of these programs would reduce career progression issues and provide longer trajectories for a productive program of research. For the second-degree BSN student (a common educational option for students in the US and Canada) who may have previous work experience and/or a graduate degree in another field, direct entry into a PhD program might also be more attractive than completing a master's in nursing and then starting a PhD. Furthermore, PhD study in other health-related fields, such as sociology or public health, does not require previous work experience for their candidates. With no clear consensus on the minimum number of years of clinical experience (if any) nursing faculty should have nor how recent it should be, the debate about BSN to PhD programs will likely continue. As different types of students enter the profession, the discussion will also become more nuanced. Studies such as this one can help provide some answers to what potential students want and inform strategies for increasing faculty supply.
Methods To pursue this exploratory pilot study, we used a descriptive, crosssectional approach to evaluate programmatic options for BSN to PhD study in nursing that would include an internal survey of matriculated students and review of national admission requirements for BSN to PhD programs. Human subjects' approval for the study was obtained from the institutional review committee at New York University. Our study focuses on US nursing, but we believe the topic has relevance across the globe. We began our investigation by collecting BSN to PhD program data from the websites of the 71 US schools of nursing that offer the study option. Admission requirement data collected for this part of the study included Graduate Record Examination (GRE) (or equivalent) score requirements (a national standardized examination that assesses applicants' verbal and quantitative skills), minimum grade point average (GPA) (a standard measure [i.e. grade] of faculty assessment of students' course performance — see Table 1 for scoring equivalents on a 100 point scale), minimum Test of English as a Foreign Language or equivalent test scores, work experience in nursing requirements, and other program specific pre-requisites. Because no survey to measure intent for graduate study in nursing exists, the group proceeded with a consensus model of expert panel review to develop questions for the student survey. Questions were developed by the core team, reviewed by the expert panel of experience PhD educators, and finalized through a consensus process. Prior to distribution to bachelor's and graduate students through the internal listserv system, we tested the question content and functionality of the online survey with a group of ten students who were not eligible to participate in it. No content validity or functionality issues resulted from the test. The final online survey contains ten questions, three of which gather demographic data, including program track (e.g. second-degree BSN student). Through multiple choice options, students are asked questions about their awareness of the BSN to PhD study option, to rate the likelihood of pursuing a BSN to PhD program, the reasons for not pursuing a PhD degree immediately following graduation from their current program, and their desire to complete a formal master's degree program vs. a master's in passing (the latter a common occurrence in arts and sciences programs). Research area of concentration, while specific to the school in terms of faculty match, covers common areas of study in nursing. One open-ended question at the end of the survey asked them to describe factors that might inhibit them pursuing a PhD at present or within five years. For online data collection, the software was set to not collect identifying data during the survey and IP addresses were set to be blocked during survey collection. A unique identifier was generated by the online survey data collection software. No data on number of views or participation rates were collected.
Table 1 US grade point average (GPA) four point scale equivalency to a 100 point grading scalea. GPA
Points Out of 100
4.0 3.7 3.3 3.0 2.7 2.3 2.0b 1.7 1.3 1.0 0.7
95–100 90–94 87–89 83–86 80–82 77–79 73–76 70–72 67–69 63–66 60–62
a
Points may vary slightly between universities. Less than 2.0 is considered failing for some US nursing programs. b
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
A. Squires et al. / Nurse Education Today xxx (2013) xxx–xxx
To participate in the survey, students had to be matriculated into any of the school's educational programs, except the PhD program. Our urban university located in the northeastern United States has a large enrollment, with a Fall 2011 census of over 1600 students across all programs. The BSN program is the largest one. Our nursing school also has a degree track for students who have a bachelor's degree in another field to complete a nursing bachelor's in 15 to 18 months. At present, these second-degree BSN students comprise 80% of the BSN student body and the majority are enrolled full time. This type of nursing education option is increasingly common in the US and has been instrumental in frontline nursing workforce development (Institute of Medicine, 2011). The school's location in New York City also creates a very diverse student body at all program levels and includes a large number of immigrant and international students from all over the world. Fall 2011 undergraduate student demographics included 12% Asian or Pacific Islander, 7.5% African American or Black, 10.5% Hispanic, 4% mixed race, 55% Caucasian, and 10% did not indicate a racial or ethnic identity. Men represent approximately 12% of BSN program enrollment. Master's degree program enrollment demographics are similar, although most students are part-time. Once eligibility was determined through reviews of enrollment lists, the survey link was distributed to 1385 eligible students registered in the Spring 2010 and 2011 semesters via internal email listservs appropriate for their program track. This allowed the study's team to capture two cohorts of BSN students and the majority of matriculated master's students. The invitation email asked students to voluntarily participate in the study, with informed consent assumed if they chose to complete the survey. Over a two-month period during each data collection period, email invitations with three reminders to encourage completion were sent and students received no incentives for participation. The survey's programming required respondents to answer all the questions except the open-ended one in order to maximize survey completeness. Respondents could go back and change their answers as they took the survey or quit the survey at any time. We generated descriptive statistics from the survey's responses and followed with a Pearson chi-square analysis with Fisher's exact test correction to determine if there were significant differences in the responses based on a subject's age or program type. For the open-ended question, a general content analysis was conducted on the student comments to determine the common themes and frequency among the responses. Results We discuss the results in two parts and according to the aims. We begin first with the BSN–PhD program admission criteria review and then follow with the results of the pilot student survey. BSN–PhD Admission Criteria Review Table 2 illustrates the findings from the initial review of the 71 universities that offer a nursing BSN to PhD option showed a range of grade point averages (GPAs) (measured on a four point scale common in the US, with 4.0 the highest average possible) required for entry into the BSN to PhD program. The average, minimum GPA requirement was 3.14 and ranged from 2.75 to 3.5. Across PhD programs, GPA requirements were higher for BSN to PhD programs than for students who already had a master's degree. GRE test scores were not listed for 65% of the schools and among those that did list them, the minimum combined score on math and reading was 1000, the mean was 1070, and ranged from 1000 to 1500. Some schools waived the GRE for a specific GPA or required a GRE score if GPAs were lower than the cutoff. Test of English as a Foreign Language (TOEFL) usually required a minimum 550 score (or equivalent in another testing format) on the written test and programs did not specify if they needed a test with a speaking requirement.
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Table 2 BSN–PhD program application requirements.*
Undergraduate GPA Graduate GPA GRE Combined Math & Verbal Work experience requirement Pre-requisites Other requirements
N = 71
# of schools with information not listed
Mean: 3.14
21
Mean: 3.21 Mean: 1070 1 school did not require GRE • 4 schools with 1 year minimum • 1 school with 2 year minimum • 17 require graduate level statistics • 11 schools do not require GRE • Interview • 500 clinical work hours • Percentile minimum for GRE within the field • Minimum standard for statistics course grade
25 49 N/A N/A N/A
*TOEFL scores not listed.
A graduate level statistics course was a common pre-requisite in about a third of the schools, along with an admissions interview. Only five programs required at least one year of clinical work experience as an RN before matriculating in a BSN to PhD program.
Student Survey Results A total of 606 students participated, resulting in a 57% response rate — well above the minimum 40% required for internet-based surveys recommended by Whitehead (2007). Respondents between ages 18 and 30 represented 64% (n = 387) of the sample, with 20% (n = 121) of respondents between 31 and 40 and the remainder age 41 or older (n = 98). Respondent demographics, in terms of race and ethnicity, either matched internal demographics or varied ± 2%. By program track, 15% (n = 91) of the respondents were traditional, four-year bachelor's degree students; 38% (n = 230) accelerated bachelor's degree students; 3% (n = 18) dual degree BSN–MSN students (students pursuing a master's directly after their bachelor's); and 42% (n =254) master's degree students. The remaining 2% (n = 12) of the respondents were in the DNP program. We did not collect participant data on marital status or number of children. We report the remaining results of the pilot survey in the order the questions appear in the survey. To begin, sixty-seven percent of overall respondents had never heard of a BSN to PhD study option (63% of bachelor's degree students vs. 72% of master's students). Sixty-nine percent indicated they might or definitely would consider pursuing a PhD directly from their current program of study. That level of interest was consistent across bachelor's and master's programs. Students already enrolled in a dual degree BSN–MSN program were three times as likely to indicate that they would continue their studies on to the PhD level (59% vs. 20%). The number one reason why students would not immediately matriculate into a PhD program from their current program was that they wanted to work and gain experience either as a staff registered nurse or in their new graduate level education role, usually as a nurse practitioner. Forty-two percent of the students indicated that reason on the survey, followed by 34% indicating they were not interested in a research career at the present time. The content analysis of the open-ended question responses shed further light into the reasons and barriers for pursuing PhD study. Of the 427 students who opted to provide comments, the analysis produced three themes: cost, time, and experience. Other concerns related to a lack of a match between graduate study options and the institution's programmatic offerings, determining if a DNP was a better fit for their interests, and the age of the respondent as a factor in decision-making, with older candidates less likely to progress to the
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
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PhD level. The responses overall were captured best through this quote: “I appreciate great intellect. I believe that health care demands great intellect. The challenge is that it is constantly evolving and we are faced with a system that is now defined by evidence-based practices. With these ever changing dynamics, a PhD seems to fit into this evolution. The conflict is money, time, and energy.” Cost concerns comprised 68% of the comments. These broke down into categories related to an already high amount of debt (largely student loan related), the financial impact on their families of leaving work for school, and uncertainty over job prospects after graduation. A number of students indicated that health insurance was another cost factor that informed their decision about whether or not to pursue a PhD. Many students expressed a desire to continue working in some capacity to either offset tuition costs or lessen the economic impact on their families. Time concerns (33% of comments) mostly fell into categories related to the length of the program since giving up a full time salary for up to five years was a significant concern. Students also felt they had spent a lot of time in school already and needed a break, or indicated they had no intention to return at the time of the survey. Conflicts with work schedules and time spent away from family beyond what they already experienced with their current educational program or nursing job were also factors. Timing was another category as many students commented about their plans to have children in the near future overriding their desire to pursue graduate study or the current age of a respondent's children influencing their decisions. The entire theme is best illustrated by the following quote from a student: “I want to work, make money, get married and raise a family…and have a daily impact on patients. Cost–benefit analysis does not support attaining a PhD. The value of graduate school in a professional program that trains one to perform a specific job is that it greatly increases earnings potential and job opportunities/security…and patient impact. No interest in pursuing research for the sake of academic curiosity.” Finally, the third, and perhaps most surprising, theme and reason students listed as a factor in their decision to pursue a PhD was lack of clinical experience on their part and the desire to gain it before pursuing a research degree. One student commented, “I think I should work for at least one year before pursuing another degree. I think the nursing program is great, but there is a lot to learn on the floor that you just can't get from school.” Another student indicated that experience would inform the decision of what type of graduate study to pursue and her area of interest when stating: “I think having work experience as a nurse would contribute greatly to my effectiveness as a researcher — determining what area of research to pursue, how to navigate the health-care environment effectively, even in the level of respect afforded by peers/colleagues. I think practical experience helps form a very important base of knowledge for a researcher.” No student made a comment in support of direct entry without first gaining experience, even if it was as little as one year. With barriers and facilitators for PhD study more clearly defined and money issues one of the top barriers, students then responded to a question about full tuition funding and living stipend and its effect on changing their decision about studying for a PhD. Eighty-seven percent of the students indicated that they would be more interested in the PhD study if they had their tuition covered and a living stipend to offset the financial losses nurses experience when they leave full time healthcare jobs for PhD study. The remaining respondents said tuition and stipend support would have no effect on their decision at this time.
The final question sought to gauge students' area of interest for PhD study and could focus on any age group of a population. Topics selected were based on where the school's core faculty strengths exist, with level of interest gauged on a four point scale (4 = Extremely interested, 1 = Not interested) and illustrated in Fig. 1. Sixty-two percent of the respondents indicated their greatest topic area of interest was in developing research skills for studies of disease management and interventions, either infectious or non-communicable, across age groups and specific populations. Non-communicable diseases were the number one topic of interest with 68% of the respondents indicating this topic as their primary area of interest, followed by global health at 52%. The remaining 38% were interested in health services and policy research. HIV/AIDS, geriatrics, and nursing workforce studies had less interest indicated by students as potential topics for PhD study. These results suggest where students' research interest may lie as they are completing their programs and demonstrate that they can reflect the research emphasis of the institution where they study. For long term workforce development, results show that trends in the area of interest did vary by students' educational levels. Pearson chi-square analysis with Fisher's exact test correction demonstrated graduate students were more likely than bachelor's students to indicate “a lot of interest” in studying nursing workforce issues (p = .029), suggesting that work experience does influence areas of interest in PhD study. For geriatrics, bachelor's students were evenly split between their interest or disinterest in it as research area for a PhD and masters students were significantly less interested overall in studying geriatrics (p = .005). Age was not a significant factor related to area of interest for PhD study and no other significant relationships were found.
Discussion Our findings confirm results from other studies that cite time and money as factors influencing any kind of graduate study in nursing (Alexander et al, 2002; Edwards et al, 2009; Lee, 2008). However, we could not locate any studies about nurses going directly from BS to PhD. If we are to produce enough faculty to teach the next generation of nurses, the BS to PhD option may facilitate achieving that goal. Even though this was a pilot study, the data provided many useful insights into the reasons why students may or may not choose to pursue a research career shortly after finishing their bachelor's degree and provides some support for the work completed by Kovner et al. about new graduate nurse career paths (Kovner et al, 2012). With regard to PhD program admission criteria, the variety is not surprising since they reflect the rigor of different university programs. GRE scores also become less significant predictors of success in graduate school with older candidates, who are more common in US nursing programs and the test itself may be a deterrent to admission (Katz et al, 2009; Megginson, 2011). It is also interesting that only 5 programs required clinical work experience as a nurse before PhD study. If graduates plan to focus on research career, clinical experiences from their undergraduate programs may be sufficient. If on the other hand they plan to teach undergraduate students or have a clinical position, experience as a registered nurse may be important. More detailed information about the rationale for requiring or not requiring immediate post undergraduate clinical experience would inform developing programs assess their clinical requirements. From the student perspective, it is clear that the cost of education is the main issue related to pursuing PhD study in nursing in the US. For American students and students from countries where loans are a common way to pay for an education, they may be reluctant to assume additional debt for another degree. The US context may require more innovative policy options to overcome this barrier. For example, when full tuition funding is not available, creative alternatives that reduce work restrictions could include the ability to work per-diem or parttime to ensure a nurses' financial stability during graduate education
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
A. Squires et al. / Nurse Education Today xxx (2013) xxx–xxx
5
3.5
3
2.5
Level of Interest
2 DNP
1.5
BS Accelerated BS BS dual degree
1
MS Average
0.5
0 Global Public Health
Geriatrics
HIV/AIDS – Infectious Diseases
Prevention/intervention Studies
Nursing Workforce/Outcomes
Non-Communicable
Health Policy & Systems
Level of Interest Scale: 1 = No interest 2 = Some Interest 3 = A lot of interest 4 = Extremely interested
Fig. 1. Research areas of interest for doctoral study.
or offset the significant wage losses many students (with previous work experience) would endure when continuing their studies. Other findings related to family also suggest that child-bearing age students and eventual graduates from PhD programs may need additional mentoring and support to help them balance work–family demands. Since pursuing a PhD may decrease the financial resources available to pay for child care, universities preparing PhD graduates may need to develop resources for child care when they are not readily available. Students will also pay attention to how universities handle maternity leave among child-bearing age faculty. While this issue will vary among countries, it will be a greater issue when paid maternity leave is not available. In contrast to some previous opinions, the results showing that students perceived working as a nurse in some capacity as an important piece of professional experience that can inform their choices and topics of study in a PhD program is an important result, even as most admission requirements for BSN to PhD programs in the US did not require work experience as a nurse. The significant differences in responses between bachelors and graduate students in this area further reinforced that idea. PhD programs that produce graduates with little frontline work experience may need to consider how it affects their employability in faculty roles, although additional studies are needed to determine how clinical experience affects career paths of PhD prepared nurses. Our assessment of student areas of interest for research concentration reflects our university's internal areas of expertise and may not translate well across other programs. While the students' strong interest in non-communicable diseases (NCDs) and global health potentially bodes well for producing future researchers and experts in this area at both domestic and international levels, the lack of interest in geriatrics is discouraging considering the global aging population. The statistically significantly greater interest in workforce studies among master's students suggests that recruiting PhD candidates with health system work experience may be the best pool for recruitment to produce health workforce researchers.
While this study revealed some of the influences on student decision-making behind pursuing PhD study in nursing, it does have some limitations. First, an internal study at a large, an urban university in the US may not produce results applicable to nursing programs in other geographic areas. Despite a strong overall response rate for an internet-based survey, this study did not differentiate responses by race and ethnicity due to sample size concerns. Future studies should look at the effect of other dimensions of identity on student intent to pursue a PhD whether through a traditional route or directly from a BSN program, including more defined ethnic and racial identity data, gender, marital status, and number of children. Some of these findings may only be relevant to US programs or those in high income countries. Issues about health insurance coverage and child care will not be relevant in countries with those services integrated into their social support systems. The pilot study results do suggest the questions designed for this survey produce responses that can yield rich results. Further refinement of the instrument will be necessary before replication in a larger, national survey. Adding questions about individual amount of debt, loan forgiveness programs and other questions related to financial, time, and gaining work experience will enhance the reliability and validity of the survey. Expanding the depth of the demographic questions to match research in sociology about career path progressions (e.g. marital status, number of children, etc.) will also enhance the quality of future studies. Recent findings from the RN Workforce project around workforce mobility (Kovner et al, 2012) also suggest that questions that can gauge a nurse's willingness or ability to move to pursue PhD study would also add another useful dimension to the survey. Conclusions This study produced valuable descriptive data that introduce and confirm many factors nursing faculty knew were anecdotal determinants of pursuing PhD study, but had yet to be quantified. The pilot data suggests that we need a better understanding of the factors
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influencing the career paths of nurses and the decision-making processes behind them. In addition, every country will also have their own unique factors that will influence the pursuit of PhD study and those should be captured through qualitative and quantitative approaches. Consistent investment in the next generation of nursing faculty is critical for sustainable healthcare systems. Studies like this one are one of many steps and policy initiatives needed to ensure sustainable nursing human resources production in a country. Acknowledgments Data from this manuscript was first presented at the 2011 AACN Doctoral Education conference. The authors would also like to thank Philip Johnson, Jamie Rose Carroll, and Lauren Gerchow for their assistance preparing this manuscript. References Alexander, G.R., Chadwick, C., Slay, M., Petersen, D.J., Pass, M., 2002. Maternal and child health graduate and continuing education needs: a national assessment. Matern. Child Health J. 6 (3), 141–149. Berlin, L.E., Sechrist, K.R., 2002. The shortage of doctorally prepared nursing faculty: a dire situation. Nurs. Outlook 50 (2), 50–56. Cohen, S.M., 2011. Doctoral persistence and doctoral program completion among nurses. Nurs. Forum 46 (2), 64–70.
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Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Assessing nursing student intent for PHD study Allison Squires a,⁎,1, Christine Kovner a, Farida Faridaben a, Deborah Chyun b a b
New York University College of Nursing, 726 Broadway, 10th Floor, NY, NY 10003, USA Former chair of the Florence S. Downs PhD Program in Nursing Research and Theory Development and current Executive Associate Dean at New York University College of Nursing, USA
a r t i c l e
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Article history: Accepted 5 September 2013 Available online xxxx Keywords: Nursing education Bachelor's in nursing Doctoral study Graduate education in nursing Survey Nursing faculty
s u m m a r y Background: Nursing faculty shortages threaten a country's ability to produce the amount of nurses necessary to sustain the delivery of healthcare services. Programs that “fast track” graduate education options for registered nurses are one solution to the problem. Objectives: To 1) evaluate admission criteria into PhD programs for direct entry from a bachelor's degree; 2) ascertain bachelors and masters degree nursing students' perspectives on pursuing a BSN to PhD course of study; 3) clarify factors that influence students' decision-making processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study; 4) to test the survey questions to develop an instrument for future use. Design: A cross-sectional pilot study. Setting: A nursing program at a large urban university in the United States of America with an enrollment of over 1400 students. Participants: Currently enrolled bachelor's, master's, and doctor of nursing practice students. Methods: Students were sampled via a 10-question (including one open-ended question) electronic mail survey that included 1385 eligible subjects. Results: Among the 606 respondents (57% response rate), 63% were between ages 18 and 30 and 87% indicated that full tuition funding with a living stipend would make them more interested in pursuing a PhD. Current program track was a significant predictor of course of study and area of interest (p = .029). Analysis of the 427 respondents to the open-ended question revealed themes around “time” and “money” as the main barriers to study. The desire to gain clinical experience prior to PhD study was the third theme and an unanticipated finding. Conclusions: The questionnaire offered some predictive ability for gauging intent to study for a PhD among bachelor's and graduate degree prepared nurses. The results do offer some suggestions for nursing workforce development to help address faculty shortages. © 2013 Elsevier Ltd. All rights reserved.
Introduction Reducing nursing faculty shortages to ensure the steady production of entry-level, registered nurses (RN) to work in the healthcare system ultimately depends upon RNs with bachelor's degrees (BSN) to return to school for graduate study (Nardi and Gyurko, 2013). For many countries, the PhD level is the preferred preparation for faculty, although some countries may need to focus on bachelor's or master's level preparation of faculty before PhD preparation becomes a faculty norm. Doctorally prepared faculty are also those most likely to contribute to nursing science development and health research, thereby ensuring nursing's voice in the evidence for practice. Overall, for capacity building and health systems strengthening, nurses with research skills provided by PhD preparation are essential.
⁎ Corresponding author. E-mail address: [email protected] (A. Squires). 1 Tel.: +1 212 992 7074.
Bachelor's-to-PhD educational programs are one way to address a nursing faculty shortage. These programs take candidates as: 1) direct entry from the initial BSN entry-level program, 2) diploma or associate/technical degree nurses with previous work experience who are enrolled in a bachelor's completion program (known in the United States as an “RN-to-BSN” program), or 3) nurses with BSNs who have practiced and want to go straight through for a PhD without completing a master's degree prior to matriculation into the PhD program. With these matriculation patterns in mind, this pilot study had three goals. First, we explored admission criteria across universities in the United States (US) that have BSN to PhD programs. This step allowed us to evaluate how the profession in the US appears to address the issue. Then we aimed to ascertain bachelor's and master's degree nursing students' perspectives on pursuing a BSN to PhD course of study. Third, we sought to clarify factors that influence students' decisionmaking processes behind pursuing a PhD and identify characteristics of those who would be likely recruits for PhD study. The final aim of the study was to test the survey questions to develop an instrument for future studies. Our overall goal was to address the gaps in the
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Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
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literature on the subject and develop an instrument that could potentially provide useful institutional, regional, or national data for policies aimed at nursing faculty workforce development.
Background Despite periodic alerts about nursing faculty shortages in the literature (Berlin and Sechrist, 2002; De Young and Bliss, 1995; Nardi and Gyurko, 2013), we could not locate a study evaluating nursing students' intent to pursue PhDs in nursing. Of studies related to the question of interest, Cohen (2011) studied nurses already in PhD programs and their process of completion. Plunkett et al (2010) studied a small sample of Canadian students to examine the relationship between perceived self-efficacy and intent for PhD study and found the two strongly correlated (r = .52). Loomis et al. (2007) discerned some of the decisionmaking processes behind choosing between a clinical doctorate that does not have a research focus (known as a Doctor of Nursing Practice in the US) and a PhD course of study, with “life factors” (i.e. familial commitments, age of children, partner's employment status, etc.) serving as a significant factor for most nurses when choosing which degree to pursue. The United States' Institute of Medicine produced a highly influential report about the “Future of Nursing” in the US and it has made a global impact as a policy document (Institute of Medicine, 2011). Recommendation number 5 from the report advocates doubling the number of doctorally prepared nurses in the US by 2020 to ensure enough faculty are available for sustainable production of nursing human resources (Institute of Medicine, 2011). Furthermore, the committee recommends that evaluators monitor each school's graduates of bachelor's degree programs in nursing and ensure that at least 10% of the graduates matriculate into a graduate program within five years of graduation (Institute of Medicine, 2011). The Committee also calls for expanded funding for accelerated graduate study for nurses and urges trustees to increase nursing faculty salaries as an additional incentive to RNs to pursue graduate studies. Some of these policy recommendations can apply to the nursing profession in other countries. Even in light of the IOM “Future of Nursing” report, there is no consensus in the US nursing community about the value of BSN to PhD programs. Mason wrote against the direct-entry BSN to PhD study option because these graduates would never have worked as direct care providers (Mason, 2003). According to Mason, these RNs would not be qualified to teach entry-level nurses in core clinical courses because of a lack of “real world” patient care experience. Another argument is if patients are the source of “inspiration” for nursing research, nurses should have some experience with patients to create better quality and patient relevant research questions and studies. Olshansky (2004), however, in an editorial in response to Mason argued in favor of direct-entry BSN to PhD programs because they provide a vehicle for students who already know they want a research career to begin it quickly. She argued that graduates of these programs would reduce career progression issues and provide longer trajectories for a productive program of research. For the second-degree BSN student (a common educational option for students in the US and Canada) who may have previous work experience and/or a graduate degree in another field, direct entry into a PhD program might also be more attractive than completing a master's in nursing and then starting a PhD. Furthermore, PhD study in other health-related fields, such as sociology or public health, does not require previous work experience for their candidates. With no clear consensus on the minimum number of years of clinical experience (if any) nursing faculty should have nor how recent it should be, the debate about BSN to PhD programs will likely continue. As different types of students enter the profession, the discussion will also become more nuanced. Studies such as this one can help provide some answers to what potential students want and inform strategies for increasing faculty supply.
Methods To pursue this exploratory pilot study, we used a descriptive, crosssectional approach to evaluate programmatic options for BSN to PhD study in nursing that would include an internal survey of matriculated students and review of national admission requirements for BSN to PhD programs. Human subjects' approval for the study was obtained from the institutional review committee at New York University. Our study focuses on US nursing, but we believe the topic has relevance across the globe. We began our investigation by collecting BSN to PhD program data from the websites of the 71 US schools of nursing that offer the study option. Admission requirement data collected for this part of the study included Graduate Record Examination (GRE) (or equivalent) score requirements (a national standardized examination that assesses applicants' verbal and quantitative skills), minimum grade point average (GPA) (a standard measure [i.e. grade] of faculty assessment of students' course performance — see Table 1 for scoring equivalents on a 100 point scale), minimum Test of English as a Foreign Language or equivalent test scores, work experience in nursing requirements, and other program specific pre-requisites. Because no survey to measure intent for graduate study in nursing exists, the group proceeded with a consensus model of expert panel review to develop questions for the student survey. Questions were developed by the core team, reviewed by the expert panel of experience PhD educators, and finalized through a consensus process. Prior to distribution to bachelor's and graduate students through the internal listserv system, we tested the question content and functionality of the online survey with a group of ten students who were not eligible to participate in it. No content validity or functionality issues resulted from the test. The final online survey contains ten questions, three of which gather demographic data, including program track (e.g. second-degree BSN student). Through multiple choice options, students are asked questions about their awareness of the BSN to PhD study option, to rate the likelihood of pursuing a BSN to PhD program, the reasons for not pursuing a PhD degree immediately following graduation from their current program, and their desire to complete a formal master's degree program vs. a master's in passing (the latter a common occurrence in arts and sciences programs). Research area of concentration, while specific to the school in terms of faculty match, covers common areas of study in nursing. One open-ended question at the end of the survey asked them to describe factors that might inhibit them pursuing a PhD at present or within five years. For online data collection, the software was set to not collect identifying data during the survey and IP addresses were set to be blocked during survey collection. A unique identifier was generated by the online survey data collection software. No data on number of views or participation rates were collected.
Table 1 US grade point average (GPA) four point scale equivalency to a 100 point grading scalea. GPA
Points Out of 100
4.0 3.7 3.3 3.0 2.7 2.3 2.0b 1.7 1.3 1.0 0.7
95–100 90–94 87–89 83–86 80–82 77–79 73–76 70–72 67–69 63–66 60–62
a
Points may vary slightly between universities. Less than 2.0 is considered failing for some US nursing programs. b
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
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To participate in the survey, students had to be matriculated into any of the school's educational programs, except the PhD program. Our urban university located in the northeastern United States has a large enrollment, with a Fall 2011 census of over 1600 students across all programs. The BSN program is the largest one. Our nursing school also has a degree track for students who have a bachelor's degree in another field to complete a nursing bachelor's in 15 to 18 months. At present, these second-degree BSN students comprise 80% of the BSN student body and the majority are enrolled full time. This type of nursing education option is increasingly common in the US and has been instrumental in frontline nursing workforce development (Institute of Medicine, 2011). The school's location in New York City also creates a very diverse student body at all program levels and includes a large number of immigrant and international students from all over the world. Fall 2011 undergraduate student demographics included 12% Asian or Pacific Islander, 7.5% African American or Black, 10.5% Hispanic, 4% mixed race, 55% Caucasian, and 10% did not indicate a racial or ethnic identity. Men represent approximately 12% of BSN program enrollment. Master's degree program enrollment demographics are similar, although most students are part-time. Once eligibility was determined through reviews of enrollment lists, the survey link was distributed to 1385 eligible students registered in the Spring 2010 and 2011 semesters via internal email listservs appropriate for their program track. This allowed the study's team to capture two cohorts of BSN students and the majority of matriculated master's students. The invitation email asked students to voluntarily participate in the study, with informed consent assumed if they chose to complete the survey. Over a two-month period during each data collection period, email invitations with three reminders to encourage completion were sent and students received no incentives for participation. The survey's programming required respondents to answer all the questions except the open-ended one in order to maximize survey completeness. Respondents could go back and change their answers as they took the survey or quit the survey at any time. We generated descriptive statistics from the survey's responses and followed with a Pearson chi-square analysis with Fisher's exact test correction to determine if there were significant differences in the responses based on a subject's age or program type. For the open-ended question, a general content analysis was conducted on the student comments to determine the common themes and frequency among the responses. Results We discuss the results in two parts and according to the aims. We begin first with the BSN–PhD program admission criteria review and then follow with the results of the pilot student survey. BSN–PhD Admission Criteria Review Table 2 illustrates the findings from the initial review of the 71 universities that offer a nursing BSN to PhD option showed a range of grade point averages (GPAs) (measured on a four point scale common in the US, with 4.0 the highest average possible) required for entry into the BSN to PhD program. The average, minimum GPA requirement was 3.14 and ranged from 2.75 to 3.5. Across PhD programs, GPA requirements were higher for BSN to PhD programs than for students who already had a master's degree. GRE test scores were not listed for 65% of the schools and among those that did list them, the minimum combined score on math and reading was 1000, the mean was 1070, and ranged from 1000 to 1500. Some schools waived the GRE for a specific GPA or required a GRE score if GPAs were lower than the cutoff. Test of English as a Foreign Language (TOEFL) usually required a minimum 550 score (or equivalent in another testing format) on the written test and programs did not specify if they needed a test with a speaking requirement.
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Table 2 BSN–PhD program application requirements.*
Undergraduate GPA Graduate GPA GRE Combined Math & Verbal Work experience requirement Pre-requisites Other requirements
N = 71
# of schools with information not listed
Mean: 3.14
21
Mean: 3.21 Mean: 1070 1 school did not require GRE • 4 schools with 1 year minimum • 1 school with 2 year minimum • 17 require graduate level statistics • 11 schools do not require GRE • Interview • 500 clinical work hours • Percentile minimum for GRE within the field • Minimum standard for statistics course grade
25 49 N/A N/A N/A
*TOEFL scores not listed.
A graduate level statistics course was a common pre-requisite in about a third of the schools, along with an admissions interview. Only five programs required at least one year of clinical work experience as an RN before matriculating in a BSN to PhD program.
Student Survey Results A total of 606 students participated, resulting in a 57% response rate — well above the minimum 40% required for internet-based surveys recommended by Whitehead (2007). Respondents between ages 18 and 30 represented 64% (n = 387) of the sample, with 20% (n = 121) of respondents between 31 and 40 and the remainder age 41 or older (n = 98). Respondent demographics, in terms of race and ethnicity, either matched internal demographics or varied ± 2%. By program track, 15% (n = 91) of the respondents were traditional, four-year bachelor's degree students; 38% (n = 230) accelerated bachelor's degree students; 3% (n = 18) dual degree BSN–MSN students (students pursuing a master's directly after their bachelor's); and 42% (n =254) master's degree students. The remaining 2% (n = 12) of the respondents were in the DNP program. We did not collect participant data on marital status or number of children. We report the remaining results of the pilot survey in the order the questions appear in the survey. To begin, sixty-seven percent of overall respondents had never heard of a BSN to PhD study option (63% of bachelor's degree students vs. 72% of master's students). Sixty-nine percent indicated they might or definitely would consider pursuing a PhD directly from their current program of study. That level of interest was consistent across bachelor's and master's programs. Students already enrolled in a dual degree BSN–MSN program were three times as likely to indicate that they would continue their studies on to the PhD level (59% vs. 20%). The number one reason why students would not immediately matriculate into a PhD program from their current program was that they wanted to work and gain experience either as a staff registered nurse or in their new graduate level education role, usually as a nurse practitioner. Forty-two percent of the students indicated that reason on the survey, followed by 34% indicating they were not interested in a research career at the present time. The content analysis of the open-ended question responses shed further light into the reasons and barriers for pursuing PhD study. Of the 427 students who opted to provide comments, the analysis produced three themes: cost, time, and experience. Other concerns related to a lack of a match between graduate study options and the institution's programmatic offerings, determining if a DNP was a better fit for their interests, and the age of the respondent as a factor in decision-making, with older candidates less likely to progress to the
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
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PhD level. The responses overall were captured best through this quote: “I appreciate great intellect. I believe that health care demands great intellect. The challenge is that it is constantly evolving and we are faced with a system that is now defined by evidence-based practices. With these ever changing dynamics, a PhD seems to fit into this evolution. The conflict is money, time, and energy.” Cost concerns comprised 68% of the comments. These broke down into categories related to an already high amount of debt (largely student loan related), the financial impact on their families of leaving work for school, and uncertainty over job prospects after graduation. A number of students indicated that health insurance was another cost factor that informed their decision about whether or not to pursue a PhD. Many students expressed a desire to continue working in some capacity to either offset tuition costs or lessen the economic impact on their families. Time concerns (33% of comments) mostly fell into categories related to the length of the program since giving up a full time salary for up to five years was a significant concern. Students also felt they had spent a lot of time in school already and needed a break, or indicated they had no intention to return at the time of the survey. Conflicts with work schedules and time spent away from family beyond what they already experienced with their current educational program or nursing job were also factors. Timing was another category as many students commented about their plans to have children in the near future overriding their desire to pursue graduate study or the current age of a respondent's children influencing their decisions. The entire theme is best illustrated by the following quote from a student: “I want to work, make money, get married and raise a family…and have a daily impact on patients. Cost–benefit analysis does not support attaining a PhD. The value of graduate school in a professional program that trains one to perform a specific job is that it greatly increases earnings potential and job opportunities/security…and patient impact. No interest in pursuing research for the sake of academic curiosity.” Finally, the third, and perhaps most surprising, theme and reason students listed as a factor in their decision to pursue a PhD was lack of clinical experience on their part and the desire to gain it before pursuing a research degree. One student commented, “I think I should work for at least one year before pursuing another degree. I think the nursing program is great, but there is a lot to learn on the floor that you just can't get from school.” Another student indicated that experience would inform the decision of what type of graduate study to pursue and her area of interest when stating: “I think having work experience as a nurse would contribute greatly to my effectiveness as a researcher — determining what area of research to pursue, how to navigate the health-care environment effectively, even in the level of respect afforded by peers/colleagues. I think practical experience helps form a very important base of knowledge for a researcher.” No student made a comment in support of direct entry without first gaining experience, even if it was as little as one year. With barriers and facilitators for PhD study more clearly defined and money issues one of the top barriers, students then responded to a question about full tuition funding and living stipend and its effect on changing their decision about studying for a PhD. Eighty-seven percent of the students indicated that they would be more interested in the PhD study if they had their tuition covered and a living stipend to offset the financial losses nurses experience when they leave full time healthcare jobs for PhD study. The remaining respondents said tuition and stipend support would have no effect on their decision at this time.
The final question sought to gauge students' area of interest for PhD study and could focus on any age group of a population. Topics selected were based on where the school's core faculty strengths exist, with level of interest gauged on a four point scale (4 = Extremely interested, 1 = Not interested) and illustrated in Fig. 1. Sixty-two percent of the respondents indicated their greatest topic area of interest was in developing research skills for studies of disease management and interventions, either infectious or non-communicable, across age groups and specific populations. Non-communicable diseases were the number one topic of interest with 68% of the respondents indicating this topic as their primary area of interest, followed by global health at 52%. The remaining 38% were interested in health services and policy research. HIV/AIDS, geriatrics, and nursing workforce studies had less interest indicated by students as potential topics for PhD study. These results suggest where students' research interest may lie as they are completing their programs and demonstrate that they can reflect the research emphasis of the institution where they study. For long term workforce development, results show that trends in the area of interest did vary by students' educational levels. Pearson chi-square analysis with Fisher's exact test correction demonstrated graduate students were more likely than bachelor's students to indicate “a lot of interest” in studying nursing workforce issues (p = .029), suggesting that work experience does influence areas of interest in PhD study. For geriatrics, bachelor's students were evenly split between their interest or disinterest in it as research area for a PhD and masters students were significantly less interested overall in studying geriatrics (p = .005). Age was not a significant factor related to area of interest for PhD study and no other significant relationships were found.
Discussion Our findings confirm results from other studies that cite time and money as factors influencing any kind of graduate study in nursing (Alexander et al, 2002; Edwards et al, 2009; Lee, 2008). However, we could not locate any studies about nurses going directly from BS to PhD. If we are to produce enough faculty to teach the next generation of nurses, the BS to PhD option may facilitate achieving that goal. Even though this was a pilot study, the data provided many useful insights into the reasons why students may or may not choose to pursue a research career shortly after finishing their bachelor's degree and provides some support for the work completed by Kovner et al. about new graduate nurse career paths (Kovner et al, 2012). With regard to PhD program admission criteria, the variety is not surprising since they reflect the rigor of different university programs. GRE scores also become less significant predictors of success in graduate school with older candidates, who are more common in US nursing programs and the test itself may be a deterrent to admission (Katz et al, 2009; Megginson, 2011). It is also interesting that only 5 programs required clinical work experience as a nurse before PhD study. If graduates plan to focus on research career, clinical experiences from their undergraduate programs may be sufficient. If on the other hand they plan to teach undergraduate students or have a clinical position, experience as a registered nurse may be important. More detailed information about the rationale for requiring or not requiring immediate post undergraduate clinical experience would inform developing programs assess their clinical requirements. From the student perspective, it is clear that the cost of education is the main issue related to pursuing PhD study in nursing in the US. For American students and students from countries where loans are a common way to pay for an education, they may be reluctant to assume additional debt for another degree. The US context may require more innovative policy options to overcome this barrier. For example, when full tuition funding is not available, creative alternatives that reduce work restrictions could include the ability to work per-diem or parttime to ensure a nurses' financial stability during graduate education
Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004
A. Squires et al. / Nurse Education Today xxx (2013) xxx–xxx
5
3.5
3
2.5
Level of Interest
2 DNP
1.5
BS Accelerated BS BS dual degree
1
MS Average
0.5
0 Global Public Health
Geriatrics
HIV/AIDS – Infectious Diseases
Prevention/intervention Studies
Nursing Workforce/Outcomes
Non-Communicable
Health Policy & Systems
Level of Interest Scale: 1 = No interest 2 = Some Interest 3 = A lot of interest 4 = Extremely interested
Fig. 1. Research areas of interest for doctoral study.
or offset the significant wage losses many students (with previous work experience) would endure when continuing their studies. Other findings related to family also suggest that child-bearing age students and eventual graduates from PhD programs may need additional mentoring and support to help them balance work–family demands. Since pursuing a PhD may decrease the financial resources available to pay for child care, universities preparing PhD graduates may need to develop resources for child care when they are not readily available. Students will also pay attention to how universities handle maternity leave among child-bearing age faculty. While this issue will vary among countries, it will be a greater issue when paid maternity leave is not available. In contrast to some previous opinions, the results showing that students perceived working as a nurse in some capacity as an important piece of professional experience that can inform their choices and topics of study in a PhD program is an important result, even as most admission requirements for BSN to PhD programs in the US did not require work experience as a nurse. The significant differences in responses between bachelors and graduate students in this area further reinforced that idea. PhD programs that produce graduates with little frontline work experience may need to consider how it affects their employability in faculty roles, although additional studies are needed to determine how clinical experience affects career paths of PhD prepared nurses. Our assessment of student areas of interest for research concentration reflects our university's internal areas of expertise and may not translate well across other programs. While the students' strong interest in non-communicable diseases (NCDs) and global health potentially bodes well for producing future researchers and experts in this area at both domestic and international levels, the lack of interest in geriatrics is discouraging considering the global aging population. The statistically significantly greater interest in workforce studies among master's students suggests that recruiting PhD candidates with health system work experience may be the best pool for recruitment to produce health workforce researchers.
While this study revealed some of the influences on student decision-making behind pursuing PhD study in nursing, it does have some limitations. First, an internal study at a large, an urban university in the US may not produce results applicable to nursing programs in other geographic areas. Despite a strong overall response rate for an internet-based survey, this study did not differentiate responses by race and ethnicity due to sample size concerns. Future studies should look at the effect of other dimensions of identity on student intent to pursue a PhD whether through a traditional route or directly from a BSN program, including more defined ethnic and racial identity data, gender, marital status, and number of children. Some of these findings may only be relevant to US programs or those in high income countries. Issues about health insurance coverage and child care will not be relevant in countries with those services integrated into their social support systems. The pilot study results do suggest the questions designed for this survey produce responses that can yield rich results. Further refinement of the instrument will be necessary before replication in a larger, national survey. Adding questions about individual amount of debt, loan forgiveness programs and other questions related to financial, time, and gaining work experience will enhance the reliability and validity of the survey. Expanding the depth of the demographic questions to match research in sociology about career path progressions (e.g. marital status, number of children, etc.) will also enhance the quality of future studies. Recent findings from the RN Workforce project around workforce mobility (Kovner et al, 2012) also suggest that questions that can gauge a nurse's willingness or ability to move to pursue PhD study would also add another useful dimension to the survey. Conclusions This study produced valuable descriptive data that introduce and confirm many factors nursing faculty knew were anecdotal determinants of pursuing PhD study, but had yet to be quantified. The pilot data suggests that we need a better understanding of the factors
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influencing the career paths of nurses and the decision-making processes behind them. In addition, every country will also have their own unique factors that will influence the pursuit of PhD study and those should be captured through qualitative and quantitative approaches. Consistent investment in the next generation of nursing faculty is critical for sustainable healthcare systems. Studies like this one are one of many steps and policy initiatives needed to ensure sustainable nursing human resources production in a country. Acknowledgments Data from this manuscript was first presented at the 2011 AACN Doctoral Education conference. The authors would also like to thank Philip Johnson, Jamie Rose Carroll, and Lauren Gerchow for their assistance preparing this manuscript. References Alexander, G.R., Chadwick, C., Slay, M., Petersen, D.J., Pass, M., 2002. Maternal and child health graduate and continuing education needs: a national assessment. Matern. Child Health J. 6 (3), 141–149. Berlin, L.E., Sechrist, K.R., 2002. The shortage of doctorally prepared nursing faculty: a dire situation. Nurs. Outlook 50 (2), 50–56. Cohen, S.M., 2011. Doctoral persistence and doctoral program completion among nurses. Nurs. Forum 46 (2), 64–70.
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Please cite this article as: Squires, A., et al., Assessing nursing student intent for PHD study, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/ j.nedt.2013.09.004